PTOS 5.6 - User`s Guide
Patterson PTOS 5.6
User’s Guide
PTOS
Volume II
©
2012 Patterson Medical Supply, Inc. All rights reserved.
Microsoft and Windows Explorer are trademarks of Microsoft Corporation
All other trademarks, which appear in these pages, are the property of their respective owners.
COPYRIGHT NOTICE
This software and operations manual are both protected by U.S. Copyright Law that (Title 17 United
States Code.) This software and publication have been provided subject to a license agreement which restricts their use. No part of this software or user manual may be copied or distributed, disclosed, transmitted or reduced to any electronic medium without the express written permission of PTOS
Software, A Patterson Medical Company. Infringement of copyright can result in criminal prosecution, fines and imprisonment, in addition to civil damages.
DISCLAIMER
This software and manual are provided on an “as is” basis. Except for the warranty described in the
PTOS software license agreement, there are no warranties expressed or implied, including but not limited to implied warranties of merchantability or fitness for a particular purpose, and all such warranties are expressly and specifically disclaimed.
In no event shall PTOS Software, A Patterson Medical Company, be responsible for any indirect or consequential damages or lost profits, even if PTOS Software, A Patterson Medical Company, had been advised of the possibility of such damage.
Patterson PTOS
1201 Althoff Dr.
Effingham, IL 62401
Technical Support 800.824.4305
Technical Support Fax 217.342.4571
Contents
i
User’s Guide – Patterson PTOS 5.6
Contents
PTOS 1
System Requirements ................................................................................................................ 1
Local Area Network .................................................................................................................. 1
Keyboard Shortcut Keys ............................................................................................................ 2
Logging On ................................................................................................................................ 2
The PTOS Login Menu ............................................................................................... 2
Main Screen Logo Graphics ...................................................................................................... 3
Check for Updates ..................................................................................................................... 3
Using PTOS 5
Setting Up PTOS ....................................................................................................................... 5
Setting Up Your Facility Information ........................................................................................ 5
Setting Up Your Employees ...................................................................................................... 6
User Access Rights .................................................................................................................... 8
Config Parameters ................................................................................................................... 10
Config Groups ........................................................................................................... 10
eClaims Setup .......................................................................................................................... 14
Patients..................................................................................................................................... 15
Patient Case Tab ........................................................................................................ 15
Referral/Employer Tab .............................................................................................. 18
Bill Tab ...................................................................................................................... 20
HCFA/UB04 .............................................................................................................. 21
HCFA ........................................................................................................................ 23
UB04 ......................................................................................................................... 24
eClaims Attachment Information .............................................................................. 26
Insurance Tab ............................................................................................................ 30
Enter the Primary insurance first and then follow in descending order for any additional insurance carriers. ..................................................................................... 30
Notes Tab .................................................................................................................. 31
Cogwheel ................................................................................................................... 31
Cogwheel Options Menu ........................................................................................... 32
Update Lists Information ......................................................................................................... 33
Insurance Companies................................................................................................. 33
Referrals .................................................................................................................... 35
Update Account Type Codes ..................................................................................... 36
Employers .................................................................................................................. 39
Zip Codes .................................................................................................................. 39
Lookup Table ............................................................................................................ 40
Payment Types .......................................................................................................... 40
Adjustment Type ....................................................................................................... 41
Transaction History Legends ..................................................................................... 42
ICD9 Codes ............................................................................................................... 43
Update C.P.T. Codes ................................................................................................. 43
C.P.T. Group ............................................................................................................. 44
Fee Schedule .............................................................................................................. 45
Attaching Fee Schedules to Patients .......................................................................... 48
Attaching Fee Schedules to Insurance Companies .................................................... 48
LCD Datasets ............................................................................................................ 49
CCI Datasets .............................................................................................................. 50
Contents
ii
User’s Guide – Patterson PTOS 5.6
Scheduling 52
Scheduler Setup ....................................................................................................................... 52
Resources .................................................................................................................. 52
Appointment Status ................................................................................................... 53
Appointment / Block Hold Type ............................................................................... 53
Appointment Reminder Email Template ................................................................... 54
Scheduling an Appointment ..................................................................................................... 55
Scheduling a Single Appointment ............................................................................. 55
Scheduling Multiple Appointments ........................................................................... 56
Additional Therapists ................................................................................................ 57
Additional Resources................................................................................................. 57
New Appointment (from Waitlist) ............................................................................ 58
Scheduling Blocks ................................................................................................................... 58
Creating a Single Block ............................................................................................. 58
Creating Multiple Blocks .......................................................................................... 59
Additional Therapists ................................................................................................ 60
Additional Resources................................................................................................. 60
Delete Block Hold ..................................................................................................... 61
Editing Appointments .............................................................................................................. 61
Checking In an Appointment ..................................................................................... 61
Cancelling an Appointment ....................................................................................... 61
No-Show Appointments ............................................................................................ 62
Reschedule................................................................................................................. 63
Voiding an Appointment ........................................................................................... 63
Additional Right-Click Options ............................................................................................... 64
Collect Co-Pay .......................................................................................................... 64
Enter Charges ............................................................................................................ 65
Note Complete ........................................................................................................... 66
Copy .......................................................................................................................... 66
Cut ............................................................................................................................. 66
Paste .......................................................................................................................... 66
Patient Editor ............................................................................................................. 66
Print Appointment Card ............................................................................................ 66
Print Superbill ............................................................................................................ 67
Schedule Calendar View .......................................................................................................... 67
Schedule Views ......................................................................................................... 67
Show CXL/NS Appointments ................................................................................... 67
Send Email Reminder ................................................................................................ 68
Print Preview ............................................................................................................. 68
Schedule Appointments View ................................................................................................. 68
Transfer Appointment .............................................................................................................. 69
Waitlist..................................................................................................................................... 70
Appointment / Block Void ....................................................................................................... 70
Voiding Blocks .......................................................................................................... 71
Documentation 72
Template Admin ...................................................................................................................... 72
Header ....................................................................................................................... 72
Additional Options .................................................................................................... 73
Edit Template .......................................................................................................................... 73
Paragraph Status ........................................................................................................ 73
Show/Hide Detail ...................................................................................................... 74
Copy from Note ......................................................................................................... 74
Pick Lists ................................................................................................................................. 74
User’s Guide – Patterson PTOS 5.6 Contents
iii
Patient Chart ............................................................................................................................ 75
Creating a New Note ................................................................................................. 75
Saving a Note ............................................................................................................ 76
Comparing Initial Evaluation with Re-Evaluation .................................................... 78
Note History .............................................................................................................. 79
Open Note Options .................................................................................................... 79
Closed Note Options.................................................................................................. 81
Facility Logo ............................................................................................................................ 82
Billing 84
Transactions ............................................................................................................................. 84
Enter Charges .......................................................................................................................... 84
Entering Billing information ..................................................................................... 86
Group 1 — Previous Patient Balance (excludes current charges) ............................. 88
Group 2 — Case Information (includes current charges) .......................................... 88
Group 3 — Today’s Charges (includes current charges) ........................................... 88
Charge Ticket ............................................................................................................ 89
Appointment Warning Messages ............................................................................... 90
Payments/Adjustments ............................................................................................................ 91
Account Payment ...................................................................................................... 91
Insurance Payments ................................................................................................... 92
Adjustments ............................................................................................................... 93
Insurance Payment Windows .................................................................................... 95
X-Charge Electronic Payment Processing ............................................................................... 95
System Voids on Overpayments ................................................................................ 97
Patient Transactions ................................................................................................................. 97
Summary Tab ............................................................................................................ 97
Cogwheel ................................................................................................................... 98
Overpayments - Patient Transactions ........................................................................ 99
History Tab .............................................................................................................. 100
Daily Transactions (Charges) ................................................................................................ 102
Approved Charges ................................................................................................... 102
Cogwheel ................................................................................................................. 103
UnApproved ............................................................................................................ 103
Payment ................................................................................................................... 104
Adjustment .............................................................................................................. 105
CCI/LCD Audits ...................................................................................................... 105
Void a Transaction .................................................................................................. 106
Applying Co-pay ..................................................................................................... 106
Auto-calculating Accounts Receivable .................................................................... 107
Account Aging ........................................................................................................ 107
Inactive Accounts .................................................................................................... 107
Date Range Information .......................................................................................... 107
Claims .................................................................................................................................... 107
Patient Billing ........................................................................................................................ 113
Standard Options ..................................................................................................... 114
The Statement Queue .............................................................................................. 117
Insurance Billing .................................................................................................................... 117
Insurance Billing Sort Tab ....................................................................................... 118
Standard Options Tab .............................................................................................. 119
Claims Queue Tab ................................................................................................... 120
Navigate To ............................................................................................................. 121
eClaims Setup Tab ................................................................................................... 122
Auto Assign Payer ID .............................................................................................. 123
Setting up Unpaid Balances ..................................................................................... 124
User’s Guide – Patterson PTOS 5.6 Contents
iv
Using Unpaid Balances ........................................................................................... 125
Claims .................................................................................................................................... 126
ERA ....................................................................................................................................... 126
View ERA in Claims ............................................................................................... 127
The ERA Queue ...................................................................................................... 127
Overpayments - ERA Payments .............................................................................. 128
Bulk Payments ......................................................................................................... 128
Date of Service Filter............................................................................................... 128
Flexible Bulk Payment Distribution ........................................................................ 129
Overpayments - Bulk Payment Windows ................................................................ 130
HIPAA (ASC) X12 Version 5010 Standard .......................................................................... 131
Worklist 132
Using the Worklist ................................................................................................................. 132
Appointments .......................................................................................................... 132
Notes ........................................................................................................................ 132
Interfaces 133
Using Interfaces ..................................................................................................................... 133
Config Parameters ................................................................................................... 133
Exported Files .......................................................................................................... 133
One Time Export ..................................................................................................... 134
Import Files ............................................................................................................. 134
Reports 136
Report Options ....................................................................................................................... 136
Report Views ........................................................................................................... 136
Export Options ........................................................................................................ 136
Favorites .................................................................................................................. 137
Aged Accounts Receivable Reports ....................................................................................... 137
Customized Date Range A/R Report ....................................................................... 138
Analysis Reports .................................................................................................................... 139
Treatment Lists ...................................................................................................................... 140
Financial Lists ........................................................................................................................ 141
Demographic Lists ................................................................................................................. 142
Code Lists .............................................................................................................................. 142
Transaction Lists .................................................................................................................... 143
Documentation Reports ......................................................................................................... 144
Scheduling Reports ................................................................................................................ 144
System Tasks 146
Supervisor .............................................................................................................................. 146
Config Parameters ................................................................................................... 146
Data Sources ............................................................................................................ 147
Facility ..................................................................................................................... 147
Employee ................................................................................................................. 147
Merchant Services Setup ......................................................................................... 148
User Access Rights .................................................................................................. 150
User Groups ............................................................................................................. 150
Check for Updates ................................................................................................... 151
Update Lists ........................................................................................................................... 151
Login Summary ..................................................................................................................... 151
Currently Logged Summary .................................................................................... 152
User’s Guide – Patterson PTOS 5.6 Contents
v
Object Lock Details ............................................................................................................... 152
Export Application Errors ...................................................................................................... 152
Technical Support Utility ....................................................................................................... 153
System Copy............................................................................................................ 153
Copy Size ................................................................................................................ 154
Restore Copy ........................................................................................................... 155
Special Tasks 156
Remove Old Accounts ........................................................................................................... 156
Inactivate Cases ....................................................................................................... 156
Archive Patients ...................................................................................................... 156
Add/Update Client Logo ........................................................................................................ 157
Tools 158
Worklist ................................................................................................................................. 158
Login as Different User ......................................................................................................... 158
Help 159
PTOS Help Menu .................................................................................................................. 159
Online Center ......................................................................................................................... 159
Contact Support ....................................................................................................... 159
FAQ ......................................................................................................................... 159
About PTOS .......................................................................................................................... 160
System Backups ..................................................................................................................... 160
Creating Your Backup ............................................................................................. 160
Storing Your Backup ............................................................................................... 160
Glossary of Terms 161
PTOS Website 165
Additional Seminars ................................................................................................ 165
FAQ ......................................................................................................................... 165
Enhancement Suggestions ....................................................................................... 165
Support .................................................................................................................... 165
Index 166
User’s Guide – Patterson PTOS 5.6 Contents
vi
PTOS
System Requirements
Memory – We recommend a minimum of 2 gigabytes of memory for a server/workstation. (Recommend 4 gigabytes or higher for best results)
Display – PTOS for Windows requires a monitor with a video resolution capable of 1024 x 768.
High Speed Internet – PTOS requires high speed Internet connection when downloading updates.
Web Browser – PTOS recommends using Internet Explorer when downloading updates from our website.
Local Area Network
If you will be running PTOS on a network, there are several considerations to keep in mind. First, you MUST have a Multi-
User version of PTOS.
Operational Considerations – The Network version of PTOS allows a high degree of freedom when using various data entry and reporting routines. As with any multi-station data entry system, however, certain precautions should be taken into consideration. These considerations can be summed up in one statement: “No data can be entered that will affect the results of another operation taking place at that same time.” Specific considerations are listed below.
folder and all of its sub-folders and files. In addition, all workstations must have Administration Rights to their local temp folder and its files.
You can direct printing to any printer on the network by selecting Special Tasks
Print Administrator.
Printing can also be redirected at the time sending output to a printer is selected. If you use print spooling, it is up to your hardware consultant to set the spooler
User’s Guide – Patterson PTOS 5.6 PTOS
1
correctly. If this is not set correctly, documents can be lost.
Keyboard Shortcut Keys
The following is a list of function keys that can be used in PTOS:
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Logging On
Double-click the PTOS icon or select PTOS from the Program list.
The PTOS Login Menu
Database: Select your main database for daily work or your archive database.
The system date will default to today’s date; however; the option to return to a previous system date is available. Use the dropdown menu to select a Database. Enter a username and
password to log into PTOS.
To exit PTOS, select Exit on the toolbar.
User’s Guide – Patterson PTOS 5.6 PTOS
2
Select Yes to exit. Select No to continue.
Main Screen Logo Graphics
To access the PTOS Background Image preference, go to
Special Tasks | Show PTOS Background Image and check this feature to have the main screen appear upon opening the software. Uncheck if the main screen is not wanted upon startup.
Check for Updates
Periodically, it is necessary to check for updates to your PTOS.
Before you update your software, it is recommended that you have a verified backup that can be restored if necessary.
To check for updates, select System Tasks
Supervisor Check
for Updates.
Select Yes to continue. Select No to exit without continuing.
User’s Guide – Patterson PTOS 5.6 PTOS
3
To continue downloading updates, select Yes. Select No to exit without updating. The following window appears.
Select OK to finish installing updates.
Select OK to launch the PTOS application.
User’s Guide – Patterson PTOS 5.6 PTOS
4
Using PTOS
Setting Up PTOS
Before you can realize the full potential of PTOS, you must set up the basic information. This chapter will walk you through the basic setting up of PTOS for your office needs.
Setting Up Your Facility Information
The Tax ID number cannot be edited from this screen. This number is supplied by your licensing information.
Under System Tasks | Supervisor | Facility enter your facility information. Enter your demographic information including
Scheduling Start/End time and Scheduling Time Duration.
In the PTPN Information section, enter the Office and DBA information.
Select the checkboxes to designate this facility as the Insurance
Billing Remittance Facility and/or Patient Billing Remittance
Facility.
User’s Guide – Patterson PTOS 5.6 Using PTOS
5
Select the Practice Identification button to enter additional identification numbers such as License, UPIN and insurance group numbers.
Select OK to save.
Setting Up Your Employees
Required fields are denoted with asterisks.
Under System Tasks | Supervisor | Employee, create and/or edit the employees of your facility. If you have purchased the
Scheduling program separately, you will need to create all employees: both therapists and office staff. While creating/editing
User’s Guide – Patterson PTOS 5.6 Using PTOS
6
Required for therapists.
Do not alter this area without the assistance of PTOS support
.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options. an employee, all the areas indicated by a red asterisk must be filled out to save this employee.
To create a new employee, select the Add icon. Enter the Emp
ID. In the next section, enter the employee’s name, User Name,
Password and Nickname/Gender, if desired.
Under the Billing Provider Information, enter the Employee’s
Name, Address, City/State/Zip and NPI #. Also include the
Phone number(s), Email, Birth and Hire Dates, Title,
Terminated Date, Hourly Rate, Sort Order and Notes.
Under Force Password Change, select either Next Login or an
Expiration date.
Enter the employee’s NPI # (if applicable), Tax ID number (if applicable), NY state License (if applicable), Ohio Provider # (if applicable), Social Security Number, Taxonomy code, and
Statement Header.
Select Employee type and Provider on Insurance physician.
Select the Default Facility and any additional Facilities for this employee.
User Group ID – This area allows you to set up the different access levels for your employees.
Therapist Group – All employees must be assigned a Therapist
Group. If the employee is not a therapist, it will not have any effect on the schedule.
Signature Line – This area must be filled out by all Therapists.
The information in this area is how the employee’s electronic signature will look.
Signature File for Documentation – Browse to the location in which you wish to save the signature file.
Site ID
User’s Guide – Patterson PTOS 5.6 Using PTOS
7
Select the Site ID button to select the Site ID from the available options.
Therapist Info
Select Therapist Info to assign the required numbers for
Insurance Claims by Account Type.
User Access Rights
To establish administration rights for users, select System Tasks
Supervisor
User Access Rights.
User’s Guide – Patterson PTOS 5.6 Using PTOS
8
Under User Groups, select the group name. The areas associated with this User Group appear below. Select or deselect the checkboxes that allow group members to View or
Modify the selected areas of PTOS. Items with a single level of access will have View and Modify linked automatically.
User Groups are assigned to employees in the Employee screen. Another way to assign employees to User Groups is under System Tasks
Supervisor User Groups.
Select the User Group drop-down arrow to select a User Group.
Select, Add Employees to User Group, to add employees. Use the red X to remove an employee.
Select the checkbox associated with the desired employee.
Select OK.
To create a new User Group, select the Add icon or F2. Enter the description information and save.
To delete an existing User Group, select the desired group and select the Delete icon.
User’s Guide – Patterson PTOS 5.6 Using PTOS
9
Config Parameters
Configure your preferred settings using Config Parameters.
Select System Tasks
Supervisor Config Parameters.
Use the drop-down list to select a Config Group or leave this area blank to view all available options. Select the Edit icon or F3 to edit the selected parameter.
Edit the Value to suit your office’s needs. Select the Save icon to save your changes.
Config Groups
Config Groups are parameters that affect the same area of the software. The following Config Groups are available.
Billing
User’s Guide – Patterson PTOS 5.6 Using PTOS
10
Charge Ticket – Choose whether to see the Charge Ticket or
Enter Charges screen when entering charges from Scheduling and/or Documentation. This DOES NOT impact entering charges from Patient Editor or the Billing menu. Value: 1 =
Charge Ticket, 2 = Enter Charges, 0 = Neither.
AuditCheck – Value: 'Yes' = Prompt will appear during charge entry to audit codes using CCI/LCD edits. 'No' = Prompt will not appear during charge entry.
Filter Charge Ticket/Superbill – 1= Filter by 3.6 BCT. 2 = Filter by 4.5 Fee Schedule. 3 = Using 3.6 BCT but do not automatically filter codes. 4 = Using 4.5 Fee Schedule but do not automatically filter codes.
Tax Percentage – Value: Set up the sales tax percentage to be used on taxable services. This will be used on codes marked as a
Taxable Services in C.P.T. Code setup.
System Lock – Enter a closing date to create a lock disabling modification of transactions dated prior to that date. To disable the temporary lock, remove the date or enter a new date.
Auto Adjust – Value: 'Yes' = write-off amounts will automatically default when posting insurance payments. 'No' = write-off amounts will not default when posting insurance payments.
A/R Details on Daily Transaction Report – Yes = A/R totals will be printed at the bottom of report. No = Totals will not print at bottom of report.
Charge Limit Warning Threshold – User can specify to be warned within x amount of patient’s charge limit.
ERA Group Codes To Ignore – If using Electronic Remittance
Advice, specify the group code.
Use Partial Automatic (not Manual) distribution setting in
Bulk Payments. ‘Yes’ = USER manually distributes payment amount per claim & SYSTEM automatically distributes to services on each claim. ‘No’ = SYSTEM automatically distributes ALL
(payment amount per claim & services).
Bulk Payment Facility Default – 1 = Patient’s Assigned Facility.
2 = Treating Facility for the Claim.
Document
Set Watermark – Type text to appear as a diagonal watermark on closed notes (Ex: Confidential, Closed, etc.).
User’s Guide – Patterson PTOS 5.6 Using PTOS
11
Print Flow sheet in Landscape – 'Yes' = Flow Sheet prints in landscape format. 'No' = Flow Sheet prints in portrait format.
Prompt to save patient notes – 'Yes' = User prompted in
Documentation to Save when exiting a note. 'No' = the System will automatically Save everything without prompting.
eMail/Fax
Mail Host – Enter the Simple Mail Transfer Protocol (SMTP) server for outgoing messages, or the email provider's SMTP outgoing address. This information can be provided from your
Internet Service Provider (ISP) or network administrator.
*Required for email and fax capabilities.
Mailuser – Enter the email address used to send emails from
PTOS. *Required for email and fax capabilities.
Mailpwd – Specify the password provided by the Internet Service
Provider. *Required for email and fax capabilities.
MailSubject – Enter the subject line for appointment reminder emails sent to patients.
Mailport – Specify the port number to connect to on the outgoing email (SMTP). *Required for email and fax capabilities.
faxEmailServices – Specify the email address extension (such as
@efax.com or @myfax.com) used by the email fax service. PTOS links the recipient's fax number and the faxEmailServices field to form the email address of the fax.
Fromemail – Specify the email address PTOS will be using while sending email/e-fax.
Fromname – Specify the name the email sent from PTOS appears to be from (Example – American Rehab Clinic). This name will appear in the From box of outgoing messages.
Use SSL – ‘Yes’ = the email account in use supports SSL encryption. ‘No’ = the email account in use does not support SSL encryption.
User’s Guide – Patterson PTOS 5.6 Using PTOS
12
Interface
PTPN Account Output Folder Path – Specify the path to the folder where PTOS will deposit PTPN files.
Export DATA folder – Specify the paths to the folders where
PTOS will deposit the third party software import files.
Export DATA Format – Designate a file format for exported files.
(xml)
Import DATA Folder – Specify the path to the folder where PTOS will retrieve the third party software export files.
Import DATA Format – Designate a file format for imported files.
(xml)
Scheduling
NO of schedule columns – Designate the number of columns to display in the daily schedule view.
Print co-pay receipt – 1 = Co-pay receipt will print after payment is collected. 0 = Co-pay receipt will NOT print after payment is collected.
System
User Defined Field – Specify the label of the user defined field that appears in Patient Editor.
Dbbackup – Designate the path to a folder where the data backups will be stored.
Assign Patient ID – 'Yes' = System automatically increments and assigns patient IDs for new patients. 'No' = User is responsible for manually entering unique patient IDs for new patients.
User’s Guide – Patterson PTOS 5.6 Using PTOS
13
eClaims Setup
To setup your eClaims information, go to Billing
Insurance
Billing
eClaims Setup.
Reports can be manually purged from the Claims
Queue.
Under Clearinghouse Settings, select the eClaims Provider and select the ellipsis button to enter the eServices User and
Password information. Select the Browse button to locate a different path for Other Clearinghouse Image Files. Enter the
Image File Name.
Under Default Reports to be Printed, select the checkbox associated with the report that you would like to print every time claims are processed. The available reports include:
Acknowledgement of
Receipt
Amended File Detail
(RPT04A)
997
File Status (RPT02)
Batch & Claim Rejection
(RPT05)
Amended Batch & Claim
Rejection (RPT05A)
File Summary (RPT03) Provider Claim Status
(RPT10)
File Detail (RPT04) Special
Handling/Unprocessed claims (RPT11)
Under Reports Settings, enter a Purge Reports after number to designate a number of days to keep reports prior to purging.
Select the Save button to save information. Select Close to exist the screen.
User’s Guide – Patterson PTOS 5.6 Using PTOS
14
To assign Payer ID information automatically, use the Auto
Assign Payer ID.
Patients
Enter the Patient Case, Referral/Employer, Bill information and more. Patient information is Case specific in all areas except for
Patient Information, Emergency Information and Personal
Information.
Patient Case Tab
To search for existing Patients, enter a patient name in the
Search field. Once the correct patient has been selected, use the
Case drop-down menu to select a different case, if desired.
Patient Information
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
To enter a new patient, select the Patients menu
New Patient or select the New Patient icon. In the Patient Information section, enter the following information:
Patient ID (NOTE: based upon Config Parameters, this field may have a default entry)
Name
Nickname/Gender
Privacy Notification Date
Privacy Notification Expiration Date
Scenario (NOTE: This field can be edited to say anything)
User’s Guide – Patterson PTOS 5.6 Using PTOS
15
Emergency Information
In the Emergency Information section, enter the Contact Name,
Relationship and Phone number for the patient’s emergency contact.
Personal Information
In the Personal Information section, enter the patient’s address, email and contact number information. Select the OK to Contact checkboxes corresponding to the patient’s desired phone number.
Case Information
In the Case Information section, enter the following information:
First Visit Date and Hour
User’s Guide – Patterson PTOS 5.6 Using PTOS
16
Discharge Date and Hour
Discipline
Delinquency Report Note
Select the PTPN checkbox if the patient is a PTPN member.
Responsible Party
Relation to Patient – Use the drop-down menu to select the relationship information.
Name – Enter the name of the Responsible Party.
Address – Enter the address of the Responsible Party.
City/State/Zip – Enter the city, state and zip code for the
Responsible Party.
Diagnosis/Additional ICD9 Codes
In the Diagnosis section, enter the Primary ICD9 and any subsequent codes. Enter the Default Diagnosis number.
User’s Guide – Patterson PTOS 5.6 Using PTOS
17
Under the Additional ICD9 Codes, enter any additional ICD9 codes.
Referral/Employer Tab
Enter any necessary referral or patient employer information in this tab.
Referring Physician
Use the Search area to locate an existing Physician.
Enter the name of the referring physician. Review the Address,
Specialty/UPIN/NPI code, phone/fax and email information.
Enter any Notes that apply. Use the drop-down menu to select the Referral Date and Next Physician Appointment.
User’s Guide – Patterson PTOS 5.6 Using PTOS
18
Attorney/Case Manager
Use the Search area to locate an existing Attorney/Case
Manager.
Enter the Name of the Attorney/Case Manager. Review the information, Address, Phone/Fax and Specialty pertaining to this case. Enter any applicable Notes.
Primary Care Physician
Use the Search area to locate an existing Primary Care
Physician.
Enter the Name. Review the following information: Address,
Specialty/UPIN/NPI code, Phone/Fax and Email information.
Make any Notes necessary.
User’s Guide – Patterson PTOS 5.6 Using PTOS
19
Employer Details
Use the Search area to locate an existing Employer Details.
Review the Employer ID and Name, Address and Phone. Enter the Patient occupation information.
Bill Tab
In the Bill Tab, enter billing information pertaining to the patient.
In the first section, enter the following information:
Authorization Expiration Date
Authorized Visits – the number of visits recorded
Remaining Visits – the number of visits allowed minus the authorized visits.
Maximum units per Day
Charges per Day
User’s Guide – Patterson PTOS 5.6 Using PTOS
20
Payment Plan Amount and Frequency
Select the Don’t Print Patient Statement checkbox to withhold printing of statements for this case.
Select the Do Not Apply Finance Charge checkbox to withhold finance charges.
In the Charge Limit section, enter the Effective Date and
Amount for Period 1 and Period 2. Use the drop-down to select a date for Charge Limit warning based on.
Under Deductible, select the Period 1 and Period 2 Effective
Dates. Enter the Amount and Remaining Deductible Amount for the available periods.
HCFA/UB04
In the HCFA/UB04 tab, enter insurance information for the selected patient.
In the Additional CMS-1500/HCFA Boxes section, enter the
Patient Status, Patient Condition, State, and Reserved for
Local Use. For use in Box 12 enter the Date and check the Print
Signature checkbox. To receive HCFA payments, select the checkbox Authorize Payment to Office.
User’s Guide – Patterson PTOS 5.6 Using PTOS
21
When sending eClaims, the PWK section is included with applicable claims. In the Additional CMS-1500/HCFA Boxes section, select the eClaims Attach. Info button.
HCFA Box 32A - Enter an Alternate Place of Service
(POS)
There is a new ability to enter an alternate address for Box 32 on the HCFA form. This area allows for entry of place of service name, address, and Box 32A/32B identifiers.
To enter an alternate POS go to Patient Editor | HCFA-UB04 tab.
In the top section for Additional CMS-1500/HCFA Boxes, there is a new button next to Place of Service [24b] - 'Alternate Place of
Service Address'.
If the default POS of 11 is used, the information in box 32 will print as it currently does using the treating facility information, found under System Tasks | Supervisor | Facility.
If any other POS code is used (Ex: 12 = Home; 13 = Assisted
Living; 14 = Group Home; 21 = Inpatient Hospital) the new button
Alternate Place of Service Address will be enabled. Location,
Address and identifiers can be entered for services performed outside of the office.
Complete the information for the Alternate Place of Service (POS) and click OK.
User’s Guide – Patterson PTOS 5.6 Using PTOS
22
Additional UB04 Boxes
In the Additional UB04 boxes section, enter any necessary insurance and condition codes for use by the Insurance.
The following information will assist you in properly filling out insurance forms for HCFA and UB04 standards.
HCFA
1) Box 8 – Specify the patient’s marital and employment status.
2) Box 10 – Specify what the patient condition is related to.
3) Box 10, Box 10b – Is used to specify the state where the auto accident took place (dependent upon Auto Accident being selected in Box 10)
4) Box 10d – Used as a remarks field if insurance carrier requests specific information that is not specified elsewhere on the HCFA claim form.
5) Box 12 – Indicates whether the patient has given consent to authorize the release of medical or other information necessary to process the claim.
If the date field is left empty, then the patient’s first visit date should be used on the claim form.
6) Box 13 – Indicates whether the patient has given authorization for the insurance payment to be received by the office. This authorization works in conjunction with the account type setting to ‘Accept Assignment’.
7) Box 15 – Indicates if the patient has had the same or similar illness; specify the date.
8) Box 16 – Indicates the dates that the patient is/was unable to work in his or her current occupation.
9) Box 18 – Enter the admission and discharged date for any hospitalization related to the current services.
If the patient is still in the hospital, leave the “To” section blank.
10) Box 19 – Use as a remarks field if an insurance carrier requests specific information that is not specified elsewhere on the HCFA claim form.
User’s Guide – Patterson PTOS 5.6 Using PTOS
23
11) Box 20 – Use to indicate whether this claim includes charges for lab work performed by a licensed laboratory. A field to specify the amount of the lab work is also available.
12) Box 22 – Medicaid resubmission claims only. Enter the resubmission code in this box.
13) Box 23 – Used to specify the prior authorization number/s and associated date range/s.
14) Box 24b – Used to indicate the place of service, such as: a. 03-School b. 11-Office c. 12-Home f. 15-Mobile Unit g. 20-Urgent Care Facility h. 21-Inpatient Hospital j. 99-Other Place of Service
UB04
1) Box 4 (Type of Bill) – Enter the code to identify the type of billing being submitted. The default codes are 0741-0744, which designate treatment at an ‘Outpatient Rehabilitation
Facility’. The exact code is determined by whether this is the original billing run or a re-bill, and whether primary or secondary insurance. Enter any value in this box to overwrite the PTOS default.
2) Box 14 (Type of Visit) – Used to enter the code indicating the priority of this patient admission, such as: a. 1- Emergency b. 2- Urgent e. 5- Trauma f. 9- Information not available. By default, PTOS should leave this field blank. Using this option will leave box
14 blank.
3) Box 15 (Source of Referral) – Used to choose the appropriate referral source of this patient admission such as:
User’s Guide – Patterson PTOS 5.6 Using PTOS
24
a. 1-Physician Referral – By b. 2-Clinic Referral d. 4-Transfer from Hospital e. 5-Transfer from Skilled Nursing Facility f. 6-Transfer from Another Health Care Facility h. 8-Court/Law Enforcement i. 9-Information Not Available.
4) Box 18-23 (Condition codes) – Used to enter up to 6 condition codes (3 characters each) for the patient. These codes identify conditions that may affect the processing of the claim.
5) Box 30 (Reserved) – Used as a remarks field if an insurance carrier requests specific information that is not specified elsewhere on the claim form.
6) Box 31A-35A (Occurrence) – Used to enter the 2 digit code and corresponding date that identifies conditions that apply to this billing period. Box 35 has space for the From and To dates.
7) Box 31B-35B (Occurrence) – Used to enter the 2 digit code and corresponding date that identifies conditions that apply to this billing period. Box 35 has space for both a From and To date.
8) Box 39-41 – Used to indicate the value codes and amounts for primary and secondary insurance. PTOS leaves this box blank by default.
9) Box 45 – Leave Box 45 Empty (primary) contains the date of service and PTOS populates it by default. If this option is checked, it will be left empty when billing primary.
10) Box 45 – Leave Box 45 Empty (secondary) contains the date of service and PTOS populates it by default. If this option is checked, it will be left empty when billing secondary.
11) Box 50A-C (Payer Name) – Default the name of the primary insurance in 50A, secondary in 50B, and tertiary in 50C.
Entering any values here will overwrite these defaults. Some providers may have their own custom requirements for this box.
12) Box 63 (Treatment Authorization Codes) – Used to enter up to 3 assigned authorization numbers, if applicable.
13) Box 64 – Used to enter the document control number for a claim.
User’s Guide – Patterson PTOS 5.6 Using PTOS
25
14) Box 66 – Leave Box 66 empty. We recommend that you leave this box empty. Used to indicate the diagnosis version qualifier. The default value printed by PTOS is 9 to indicate
ICD9 codes. Several payers do not want the 9 to print in this box, so checking this option will clear box 66.
15) Box 69 (Print Primary ICD9) – Used to denote the diagnosis that describes the patient’s condition or reason for admission/outpatient registration. By default, this will be left blank. If checked, the patient’s primary diagnosis code will print.
16) Box 74 (Principal) – Used to enter the principal diagnosis code and date. It is required on inpatient claims when a procedure was performed.
17) Box 74A-E (Other Procedures) – Used to enter any additional diagnosis codes and dates.
18) Box 76 (Qualifier) – Used for the referring Dr.’s name, NPI number and a second identifier. If second identifier is provided, it may need to be accompanied by a 2 character qualifier code in the “qual” field of box 76. Default for this field is empty. Generally accepted qualifiers are: a. 0B (state license #) b. 1G (UPIN #) c. G2 (Commercial #)
19) Box 80 – Use this area for Remarks for Unusual Services.
20) Box 81 A-D – Free form area that allows the user to enter additional taxonomy numbers and qualifiers for boxes 81A-D on the UB04 form. By default, this will be left blank.
eClaims Attachment Information
eClaims Attachment Information
Drop-down lists of attachments that relate to eClaims can be located in the Patient Editor | HCFA tab. Locate the button in the top section - Additional CMS-1500/HCFA Boxes - 'eClaims Attach
Info'.
User’s Guide – Patterson PTOS 5.6 Using PTOS
26
Attachment Report Type Code
Remove these settings after sending the requested attachment to avoid resending the attachment information on subsequent claims.
In the Attachment Report Type Code drop-down list, the following possibilities are available to describe the type of attachment:
Admission Summary – AS
Allergies/Sensitivities Document – A3
Ambulance Certification – AM
Autopsy Report – A4
Baseline
BS
Benchmark Testing Results – BR
Blanket Test Results – BT
Certification
CT
Certified Test Report – 13
Chemical Analysis – 11
Chiropractic Justification – CB
Consent Form(s) – CK
Continued Treatment – 10
Death Notification – V5
Dental Models – DA
Diagnostic Report – DG
Discharge Monitoring Report – DJ
Discharge Summary – DS
Drug Profile Document – D2
Drugs Administered – 04
Durable Medical Equipment Prescription – DB
Explanation of Benefits (Coordination of Benefits or
Medicare Secondary Payer) – EB
Functional Goals – 07
Health Certificate – HC
User’s Guide – Patterson PTOS 5.6 Using PTOS
27
User’s Guide – Patterson PTOS 5.6
Health Clinic Records – HR
Immunization Record – I5
Initial Assessment – 06
Justification for Admission – 15
Laboratory Results – LA
Medical Record Attachment – M1
Models – MT
Nursing Notes – NM
Objective Physical Examination (including vital signs)
Document – OE
Operative Notes – OB
Orders and Treatments Document – OD
Oxygen Content Averaging Report – OC
Oxygen Therapy Certification – OX
Paramedical Results – PQ
Parenteral or Enteral Certification – PE
Pathology Report – P4
Patient Medical History Document – P5
Photographs – XP
Physical Therapy Notes – PN
Physical Therapy Certification – PZ
Physician Order – B3
Physician’s Report – PY
Plan of Treatment – 08
Prescription
B2
Progress Report – 09
Prosthetics or Orthotic Certification – PO
Radiology Films – RB
Radiology Reports – RR
Recovery Plan – 21
Referral Form – B4
Renewable Oxygen Content Averaging Report – RX
Report Justifying Treatment Beyond Utilization Guidelines
– 03
Using PTOS
28
Report of Tests and Analysis Report – RT
State School Immunization Records - IR
Support Data for Claim – OZ
Symptoms Document – SG
Treatment Diagnosis – 05
Attachment Transmission Code
In the Attachments Transmission Code section, use the dropdown list to select the desired delivery method for sending the requested documentation to the payer. These options include:
Available on Request at Provider Site – AA
By Fax – FX
By Mail – BM
By eMail – EM
Electronically – EL
File Transfer – FT
Attachment Control Number
In the Attachment Control Number section, enter the Document
Control Number (DCN) provided by the Payer. This number identifies the claim and the attachment for the payer. An
Attachment Control Number is not required when using the
Available on Request at Provider Site option in the Attachment
Transmission Code section.
User’s Guide – Patterson PTOS 5.6 Using PTOS
29
Insurance Tab
To access patient insurance information, select Patient Editor |
Insurance tab. This screen displays all insurance for this case, active or inactive. Select the Add Insurance button to add an
Insurance Company to a selected patient.
Multiple insurance companies can be added for a patient.
Enter the Primary insurance first and then follow in descending order for any additional insurance carriers.
In the Insurance tab, view Insurance information for a selected patient. Use the Add, Edit and Delete icons to alter information.
Insurance companies can be deactivated and reactivated using the Reactivate button.
User’s Guide – Patterson PTOS 5.6 Using PTOS
30
Notes Tab
In the Notes tab, enter any notations for your personal office use.
Select the Add Note button to create a new note. Select the
Delete button to delete an existing note.
Select the Save icon to save this new patient information.
Double-click on an existing note to edit. Select the Report button to create a report of all notes for a particular case.
Cogwheel
The Cogwheel provides a gateway to additional patient information. Once inside Patient Editor click on the purple cogwheel icon in the upper right of the screen to access.
User’s Guide – Patterson PTOS 5.6 Using PTOS
31
Cogwheel
Cogwheel Options Menu
Use the Cogwheel Options menu to:
Add New Case – Select this option to create a new case for the selected patient.
Copy Case – Select this option to copy the current case information into a new case.
Discharge Case – Select this option to designate a case as discharged that will populate the discharge date.
Inactivate Case – Select this option to designate a zero balance case as inactive.
Reactivate Case – Select this option to restore an inactive or discharged case to active status.
Archive Patient – Select this option to mark a patient as ready for archiving.
Enter Charges – Select this option to enter new charges for the selected case.
Bill Patient Now – Select this option to open the Patient Billing window for the selected case.
User’s Guide – Patterson PTOS 5.6 Using PTOS
32
Bill Insurance Now – Select this option to open the Insurance
Billing window for the selected case.
Payments/Adjustments – Select this option to open the
Payment/Adjustments window for the selected case.
Patient Transactions – Select this option to open the Patient
Transactions window for the selected case.
Recreate Claims – Select this option to recreate a claim.
Print Cover Sheet – Select this option to print a cover sheet for the selected case.
Add New Appointment – Select this option to open the New
Appointment window for the selected case.
Add Patient to Waitlist – Select this option to include the selected patient to the Waitlist.
Appointment Summary – Select this option to print a summary report of appointments for the selected patient.
Co-Pay History – Select this option to print a summary of past copayments.
Print Blank Patient Questionnaire – Select this option to print a blank patient registration questionnaire.
Print Blank Flow Sheet – Select this option to print a blank flow sheet.
Patient Chart – Select this option to open the Chart for the selected case.
Patient Charge History – Select this option to print a summary of past charges for the selected case. (Displays up to 12 past charges)
Update Lists Information
To begin entering and updating system codes, select System
Tasks
Update Lists. From this menu, select the specific code list that you wish to update.
Insurance Companies
Select System Tasks
Update Lists Insurance Companies.
Select an existing Insurance company from the search menu to edit or select Add to create a new insurance company. To search for a company, select the search icon.
User’s Guide – Patterson PTOS 5.6 Using PTOS
33
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
The asterisk denotes fields that are required.
Insurance ID – Enter the 6 character alphanumeric Insurance ID
Name – Enter the name of the Insurance Company
Address – Enter the Address of the Insurance Company
City/State/Zip – Enter the City, State and Zip code for the
Insurance Company.
Phone – Enter the phone number for the Insurance Company.
Fax – Enter the fax number for the Insurance Company.
Pin# – Enter the PIN for the Insurance Company.
Group# – Enter the Group number for members of an Insurance group.
Payment Group – Enter the name of the Payment Group if applicable.
Percent Paid – Enter the percentage to be paid.
Practice Identification – Enter the Practice Identification information. This number corresponds with the Facility setup ID number.
Box 9D/lic line 1 – Information entered here will appear in box 9D and 11C of the HCFA insurance form.
Box 9D/lic line 2 – Information entered here will appear in box 9D and 11C of the HCFA insurance form
Print ‘Signature on File’ in Box 31 – Select this box to print the phrase “Signature on File’ in Box 31 of the HCFA claim form, as required by some insurance payers.
Fee Schedule – Enter the Fee Schedule to be associated with this Insurance Company.
Four Digit Date – Select this checkbox to use the four digit year date.
Insurance Claim Form – Select the desired default claim form to be associated to this insurance company.
User’s Guide – Patterson PTOS 5.6 Using PTOS
34
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Max Units per Day – Enter the maximum number of units per day for the Insurance Company.
Email ID – Enter the email address for the Insurance Company.
WebSite – Enter the website associated with the Insurance
Company.
Notes – Enter any notes applicable.
Inactive – select the Inactive checkbox to remove active status.
Payer Info
EClaims Payer ID – Enter the eClaims payer id if applicable.
Payment Source – Enter the Payment Source for Payer. Use the ellipses button to launch the Electronic Payer Matching screen.
From here, you can match names and sources manually.
DO NOT AUTO ASSIGN PAYER ID – When selected, this option allows for payer IDs to be assigned automatically.
Enroll Provider Before Send eClaims – This option alerts you that the Provider has not yet been enrolled in eClaims.
Referrals
Select System Tasks
Update Lists Referrals. Use the
Search field to locate the desired referral. Select an existing code to edit or select Add to create a new referral code.
For assistance with adding or removing Referral Types, please contact the PTOS
Support team at 800.824.4305.
Referral sources can be doctors, attorneys, case managers or nurse practitioners. Referral number is a one-to-five character code that is assigned by the PTOS system.
Title – Select the preferred salutation.
Print Name – This is the referral source’s name as required in
Box 17 on the HCFA and Box 76 on UB04 forms. This also prints on the Referral report to identify the referral source.
User’s Guide – Patterson PTOS 5.6 Using PTOS
35
First Name – Enter the first name of the referral.
Last Name – Enter the last name of the referral.
Address – Enter the address of the referral office
City/State – Enter the city and state of the referral office
Zip – Enter the zip code of the referral office.
Contact – Enter the main contact person’s name.
Office Phone #1 – Enter the main phone number for the referral office.
Office Phone #2 – Enter the secondary phone number for the referral office.
Fax – Enter the fax number associated with the referral office.
Email – Enter the email associated with the referral office.
Referral Type – Select the referral type from the drop-down menu.
NPI (National Provider Identification) – This number is obtained from the physician’s office and prints in Box 17B on the HCFA and Box 76 on the UB04 forms.
UPIN (Universal Provider Identification Number) – This number is assigned by Medicare Services and may or may not be required to print on the claim forms. This six-digit alphanumeric code prints in Box 17A on the HCFA and in Box 76 on the UB04 forms.
Specialty – Enter a specialty for report tracking purposes.
WebSite – Enter the website information associated with the referral office.
Inactive – Select this checkbox to designate this referral source as Inactive. Note: referrals cannot be deleted, only inactivated.
Notes – This area is used for additional reference information.
This field will not print anywhere.
Communication Preference – Select efax or email as the preferred mode of communication with the current Referral.
Update Account Type Codes
Select System Tasks
Update Lists Account Type. Select an existing code to edit or select Add to create a new Account Type code.
The purpose for Account Type Codes is to allow your office to bill different insurance criteria required by your carriers on the
HCFA or UB04 forms and/or for grouping your carriers for statistical reports.
User’s Guide – Patterson PTOS 5.6 Using PTOS
36
Account Type Code/ Name – Enter a two-to-five alphanumeric character Account Type code. Enter the name of the account type as you would like it to display on PTOS reports.
Place of Service (POS) – This field appears in Box 24B on the
HCFA form. This is a required field.
Co-Pay Amount – Enter the amount of the co-pay attached to this
Account Type.
Charge per day – Enter the maximum charge per day amount.
Ins Cap Amount – Enter the limit for those insurance carriers who have specific limits or CAP. This field can be tracked in the transaction screen and will warn you when the patient has reached their CAP.
Accept Assignment – Use the drop-down menu to accept the assignment.
Posting Note – Enter an account note that will display in the patient’s transaction screen.
Patient Statement Notes – Enter a note that will display on the patient’s statement.
CCI Dataset – Select the checkbox to use CCI dataset.
LCD Dataset – Select the checkbox to use LCD dataset.
The Following Boxes Are Filled Out On The HCFA Form –
These fields are for additional criteria insurance carriers may require for additional information. Your office will be responsible for knowing the insurance carrier’s requirements.
The user can print primary insurance information in boxes 11A-C on secondary claims and box 9 has the option to be left blank.
User’s Guide – Patterson PTOS 5.6 Using PTOS
37
Primary Insurance:
Box 9 – Select the drop-down menu to use Fill out with other insurance information or leave blank.
Box 11 – 11C – Select the drop-down menu to use Fill out with primary information, Print ‘None’ in box, or leave blank.
Box 11D – Select Y for yes or N for no.
Secondary Insurance:
Box 9 – Select the drop-down menu to use Fill out with other insurance information or leave blank.
Box 11 – 11C – Select the drop-down menu to use Fill out with
Secondary/other information, Fill out with primary information,
Print ‘None’ in box, or leave blank.
Box 11D – Select Y for yes or N for no.
Select the following checkboxes if desired:
Print Primary Care Physician in Box 17
HCFA Box 17A/UB04 Box 76 Qualifier – Enter a qualifier number for insurance carriers.
Print UPIN in Box 17A – Use this option to print or not print UPIN
Leave Box 24J White Blank
Use Provider SSN (HCFA 25/UB04 5)
Print One Date Per Page
The Following Boxes Are Filled Out On The UB04 Form –
These fields are for additional criteria insurance carriers may require for additional information. Your office will be responsible for knowing the insurance carrier’s requirements.
Select from the following checkboxes if desired:
UB04 Print Entire Date Range in Box 6
Add Leading 0 to Rev Codes
UB04 VISIT Rev Code – Enter the UB04 Visit revenue code.
Print NPI in Box 56
Print Rev Code in Box 44 of UB04 Summary
User’s Guide – Patterson PTOS 5.6 Using PTOS
38
The Employer number can be up to seven characters alphanumeric.
Print Modifier on HCFA/UB04 – Use the drop-down list to select
Y, N or leave Blank.
Employers
Under System Tasks
Update Lists Employers, create and/or edit Employer information. To search, enter % and select the search icon.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
To enter a new Employer, select the Add icon or select F2. Enter the Employer No, Employer Name, Address, City/State/Zip and
Phone. Select the Save icon to save.
Select the Inactive checkbox to render this Employer inactive.
Employers cannot be deleted.
Zip Codes
Under System Tasks | Update Lists | Zip Codes, create and/or edit the city, state and zip information. To search, enter % and select the search icon.
To enter a new zip code, select the Add icon or select F2. Enter the City, State and Zip. Select the Save icon to save. To delete a zip code, select the desired entry and select the Delete icon. Zip
User’s Guide – Patterson PTOS 5.6 Using PTOS
39
Codes are preloaded with versions 4.5 and 5.0. (See eClaims
5010 Zip Code Requirement).
Lookup Table
The Lookup Table is located under System Tasks | Update
Lists | Lookup Tables. It is a database of all abbreviations used in PTOS. Select the Add icon to add an additional code. Select the Edit icon to edit an existing code. Select the Inactive checkbox to inactivate an existing code.
The Lookup Table contains all of the abbreviation codes and their descriptions for the following areas:
Use the Inactive checkbox to render the selection unavailable.
Lookup options cannot be deleted.
Payment Types
To add, delete or edit Payment Types, go to System Tasks
Update Lists
Payment Types.
User’s Guide – Patterson PTOS 5.6 Using PTOS
40
Payment Prompt numbers refer to check numbers or credit card numbers.
Select the Add icon or F2 to add a new Payment Type. Select the Edit icon to edit an existing Payment Type. Select the Delete icon to delete an existing Payment Type.
To enter a new Payment Type, enter a Description, Payment
Prompt and select the Currency Type. Select the checkbox
Display on Statement to include this information on the patient statement.
Select the Inactive checkbox to render the selected currency type inactive.
Adjustment Type
Select System Tasks
Update Lists Adjustment Types
User’s Guide – Patterson PTOS 5.6 Using PTOS
41
To enter a new Adjustment code, select the Add icon or select
F2. Enter the Code and Description and select the Adjustment
Impact. Select the checkbox Default Type for Insurance
payments to automatically default the adjustment type when making an insurance payment. Select the Inactive checkbox to disable a selected adjustment.
Transaction History Legends
In System Tasks
Update Lists, select Transaction History
Legends to view and assign color-coding for the transactions. To assign a color, select the color box associated with the transaction. Select a Custom, Web or System to access a broader spectrum of colors. Select OK to save changes.
Default colors by type:
User’s Guide – Patterson PTOS 5.6 Using PTOS
42
Blue = Charges
Green = Open Claims
Pink = Payments
Light Blue = Adjustment
Lavender = Billed
Red = Unapplied
Orange = Finance Charges
Turquoise = Modified
Gray = Voided Transaction
ICD9 Codes
Select System Tasks
Update Lists ICD9 Codes. Use the
Search field to locate the desired code or select the Add icon to enter a new code.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Enter the ICD9 Code, Name and Injury Area. Select the Inactive checkbox to disable the selected ICD9 code. ICD9 codes are preinstalled. NOTE: Asterisks denote required fields.
Update C.P.T. Codes
Select System Tasks
Update Lists C.P.T. Codes and use the
Search field to locate an existing code or select the Add icon to enter a new code. Selecting F2 will also add a code.
User’s Guide – Patterson PTOS 5.6 Using PTOS
43
Enter the required fields for C.P.T. Code (up to ten digits), C.P.T.
Name and Charge Per Unit. Additional information fields are available for:
Cost
Time
Modifier
Units
To inactivate an existing code, select the Inactive checkbox.
Select the checkboxes to apply the following options:
Display on Charge Ticket
Display on Additional Code Tab
Bill To Patient
Display on Superbill
Count As Visit changes to the selected C.P.T. code including the date changed and the User ID of the person who made the changes.
Select the Copy button to copy the exact contents of another
CPT that already exists o
Select the CPT*Code you wish to duplicate. Hit the
Copy button to enter a unique CPT*Code for the duplicate CPT*Name, Charge Per Unit, etc. This provides a shortcut for offices selling supplies, etc. where they may want to have a similar description for a set of codes. (ex: 90111 Bandage; 90111-2 Bandage
Small; 90111-3 Bandage Medium; 90111-4 Bandage
Large, etc).
C.P.T. Group
A C.P.T. Group is a collection of C.P.T. Codes that are often used in conjunction. C.P.T. Groups are used to create ‘cascading charges’ or ‘exploding codes’. To use C.P.T. Group codes, enter the codes in the order of highest to lowest fee amount.
Select System Tasks
Update Lists C.P.T. Groups use the
Search field to select an existing code to edit or select the Add icon to enter a new group.
User’s Guide – Patterson PTOS 5.6 Using PTOS
44
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Enter a C.P.T. Group name and Description. Select from the available checkbox options:
Inactive
Bill To Patient
Display on Superbill
Display on Charge Ticket
Display on Additional Codes Tab
Select the ‘x’ in the remove column to subtract a code from an existing code group.
Fee Schedule
NOTE: Fee Schedules are optional.
Select System Tasks
Update Lists Fee Schedule. Select the
Fee Schedule Names button to create a new Fee Schedule.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
User’s Guide – Patterson PTOS 5.6 Using PTOS
45
The following window appears.
Select the Add icon to create a new fee schedule. Enter the
Fee Schedule Code and Fee Schedule Description. Select the
Save icon. Select the x to close the window.
In the Fee Schedule window, use the Fee Schedule drop-down menu to select the desired Fee Schedule. Select the Discipline.
Enter the amounts of the Insurance Reimbursement Contract Pay
Schedule. Select Save.
User’s Guide – Patterson PTOS 5.6 Using PTOS
46
Save As New
Select the Save as New button to create a new Fee Schedule based upon an existing Fee Schedule. To use the Save as New feature:
1. Select the Fee Schedule Names button to name the new
Fee Schedule.
2. Save the new Fee Schedule Name.
Schedule you wish to copy.
5. Using the drop-down list, select the Name, Discipline and
Effective From date.
6. Select Update icon.
Edit an Existing Fee Schedule
To edit an existing Fee Schedule, use the drop-down menu to select the desired Fee Schedule, Discipline and Effective From date. Once the Fee Schedule has been selected, make the necessary changes and save.
Show the Fee Schedule History
Select the Show Fee Schedule History checkbox to display the history of changes to a selected Fee Schedule.
NOTE: Each C.P.T.
Code’s information is displayed including effective dates.
Show All
Select the Show All checkbox to display all active C.P.T. Codes even if they are not currently attached to fee schedules.
User’s Guide – Patterson PTOS 5.6 Using PTOS
47
Attaching Fee Schedules to Patients
Attach the Fee Schedule to a patient in the Patient Editor.
Select Patient Editor and enter the desired patient. Select Edit.
Use the drop-down arrow to select the Fee Schedule.
The following is an example of the Fee Schedule in Patient Editor.
The Fee Schedule amount will display on the Enter Charges screen under Allow. Amt.
The following is an example of the Fee Schedule in the Enter
Charges screen.
NOTE: The Fee Schedule attached to an Insurance Company overrides the Fee Schedule attached to the Patient Case.
Attaching Fee Schedules to Insurance
Companies
Attach the Fee Schedule to an insurance company in the
Insurance Company window. Select System Tasks
Update
Lists
Insurance Company. Select the Insurance Company desired. Use the Fee Schedule drop-down list to select a Fee
Schedule from the available options.
User’s Guide – Patterson PTOS 5.6 Using PTOS
48
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
LCD Datasets
For more information on LCD data and CCI data, visit www.cms.gov/mcd.
Use your Local Coverage Determinations (LCD) Datasets to ensure that C.P.T. Codes and Diagnosis codes are payable by insurance when billed together. A warning will appear when the conflicts are present.
To setup your LCD datasets, go to System Tasks
Update Lists
LCD Dataset. In the LCD screen, select Add to setup a new list.
Enter the Name of the dataset and any comments required.
Select Save.
Using LCD data files
LCD data is frequently updated and made available to you by the
Center for Medicare and Medicaid Services. Creating a file to use with PTOS is a manual process and will require you to create a spreadsheet using this information and keeping it updated.
To add a LCD data file that you have created, select the Import
LCD Dataset File button. Use the Browse window to locate your
LCD data file. Locate the file and save.
Manually Enter LCD Data
User’s Guide – Patterson PTOS 5.6 Using PTOS
49
To manually enter conflicting codes into the LCD dataset, select the LCD Data button. In the LCD Data window, select Add to enter the allowed LCD and Diagnostic codes. Select Save to save them.
CCI Datasets
CCI Datasets are set up to prevent you from using conflicting
C.P.T. codes that should not be billed together. To setup your
CCI datasets, go to System Tasks
Update Lists CCI Dataset.
In the CCI screen, select Add to setup a new list. Enter the Name of the dataset and any comments required. Select Save.
Import CCI Data
CCI data is made available to your office by the Centers for
Medicare and Medicaid Services. A free excel file is available for download and can be imported into PTOS. The www.ntis.gov
is a government approved website that also offers these edits for download.
To add a CCI data file, select the Import CCI Dataset File button.
Use the Browse window to locate the CCI file that you have received from the www.cms.gov
website. Locate the file and save.
User’s Guide – Patterson PTOS 5.6 Using PTOS
50
The Modifier options are:
1 – Allowed
0 – Not Allowed for codes to be billed together.
Manually Enter CCI Data
To add CCI codes individually, select the CCI Data button. In the
CCI Data window, select Add to enter C.P.T. Codes, C.P.T. Code
2, Effective Date and Modifier. Select Save.
User’s Guide – Patterson PTOS 5.6 Using PTOS
51
Scheduling
Scheduler Setup
The Scheduling Admin area allows you to customize the setup and appearance of the schedule.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Resources
In Scheduling | Scheduling Admin | Resources you can create additional pieces of equipment or rooms in which to schedule your patients. These items will appear on the schedule in addition to your facility’s therapists.
User’s Guide – Patterson PTOS 5.6 Scheduling
52
You can add to the list of available resources or you can edit the existing resources in the list. Another option available is the multiple bookings option. If the resource can be used by more than one patient at a time, the Allow Multiple Bookings option can be checked and then the Max Allowed area can be set.
Enter the numerical value for the Sort Order. If it is a resource you are not going to use, the Inactive checkbox can be checked resulting in the resource being removed from the schedule.
Appointment Status
In Scheduling | Scheduling Admin | Appointment Status you can customize the colors for various appointments and block hold statuses.
Appointment / Block Hold Type
In Scheduling | Scheduling Admin | Appointment / Block Hold
Type you can create and customize the various types of appointment and block hold types for your facility.
User’s Guide – Patterson PTOS 5.6 Scheduling
53
You can create new or edit the existing Appointment and Block
Hold Types. The option to assign icons to these different types is also available. Select the Browse Icon button if you wish to see the icons that come installed. If you wish to use additional icons, the ability to import more icons is available. They must be the .ico format. If there are any types you will not be using, the option to inactivate is available.
Appointment Reminder Email Template
In Scheduling | Scheduling Admin | Appointment Reminder
Email Template you can customize an email message that can be sent to your patients to remind them of upcoming appointments.
This template is completely customizable. This message can be edited to fit the needs of your facility. The only areas that should not be edited are the <Name>, <sdate> and <stime>. These are
User’s Guide – Patterson PTOS 5.6 Scheduling
54
programming items that populate the patient’s information into the message.
Scheduling an Appointment
Scheduling a Single Appointment
To schedule a single appointment, open the schedule and either double-click or right-click on the area in which you wish to schedule the appointment and select New Appointment.
You can create an appointment using Menu
Scheduling
New
Appointment.
The New Appointment screen will open. First you will need to select the patient you wish to schedule. To do this in the
Patient Name area you can type in the patient’s last name, or you can enter % to open up a list of all of your patients. The Appt
Type and Treating Therapist must be filled out in the top portion of this screen.
User’s Guide – Patterson PTOS 5.6 Scheduling
55
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
The bottom half of the screen allows you to set the Appt Date,
Start Time, and End Time. The Duration will adjust depending on the Start and End Time of the appointment. Once all the information is entered, click on the Save icon in the upper lefthand corner to save the appointment and add it to the schedule.
Scheduling Multiple Appointments
To schedule multiple appointments, open the schedule and either double-click or right-click on the area in which you wish to schedule the initial appointment and select New Appointment.
Repeat the steps above to fill out the top portion of this screen.
User’s Guide – Patterson PTOS 5.6
Date/To Date and Start Time/End Time. The Duration will adjust depending on the Start and End Time of the appointments.
Daily – If the patient’s appointments are every day of the week, select Daily.
Weekly – If the patient’s appointments are on certain days of the week, select Weekly and then choose the appropriate days.
Scheduling
56
Selected – If the patient’s appointments are on random days, select and then click on the days the appointments need to be scheduled. The dates will populate on the right side of the screen. the appointments and add them to the schedule.
Additional Therapists
To schedule additional therapists to an appointment, select the
Additional Therapists tab.
Select the Add Therapist button to schedule an additional therapist to this appointment. Select the Delete Therapist button to remove an added therapist from the existing appointment.
Additional Resources
To schedule additional resources to an appointment, select the
Additional Resources tab.
User’s Guide – Patterson PTOS 5.6 Scheduling
57
Select the Add Resources button to schedule an additional resource to this appointment. Select the Delete Resources button to remove an added resource from the existing appointment.
New Appointment (from Waitlist)
In the Schedule, use the right-click menu to schedule a new appointment from the Waitlist. The Waitlist appears. Select the checkbox associated with the desired appointment and select the
Add New Appointment button.
Scheduling Blocks
Creating a Single Block
To create a single block, select Scheduling
New Block Hold or open the schedule and right-click on the area you wish to place the block and select new Block Hold.
The New Block Hold screen will open. The Block Hold Type,
Facility and Resource areas must be filled in. You can also add a note to the block.
User’s Guide – Patterson PTOS 5.6 Scheduling
58
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
* – Field must be completed.
The bottom half of the screen allows you to set the Date, Start
Time and End Time. The Duration will adjust depending on the
Start and End Time of the block. Once all the information is entered, click on the Save icon in the upper left-hand corner to save the block and add it to the schedule.
Creating Multiple Blocks
To create multiple blocks, open the schedule and right-click on the area in which you wish to schedule the initial block. Repeat the steps above to fill out the top portion of this screen and select
New Block Hold.
Select the Multiple Block Holds tab, enter the From Date/To
Date and Start Time/End Time. The Duration will adjust depending on the Start and End Time of the block.
User’s Guide – Patterson PTOS 5.6 Scheduling
59
In the Frequency area, there are three options:
Daily – If the Blocks are every day of the week, select
Daily.
Weekly – If the Blocks are on certain days of the week, select Weekly and then choose the appropriate days.
Selected – If the Blocks are on random days, select and then click on the days the blocks need to be scheduled.
The dates will populate on the right side of the screen.
Additional Therapists
To add additional therapists to a Block Hold, select the Additional
Therapist tab.
Select the Add Therapist button to schedule an additional therapist to this appointment. Select the Delete Therapist button to remove an added therapist from the existing appointment.
Additional Resources
To add additional therapists to a Block Hold, select the Additional
Resources tab.
Select the Add Resources button to schedule an additional therapist to this appointment. Select the Delete Resources button to remove an added therapist from the existing appointment.
User’s Guide – Patterson PTOS 5.6 Scheduling
60
Delete Block Hold
To delete an existing Block Hold, right-click on the Block and select Delete Block Hold. The following message appears.
Select Yes to delete the block. Select No to close without deleting.
Editing Appointments
You can edit any scheduled appointment by simply double-clicking the appointment. It will then open up the appointment screen.
Checking In an Appointment
When a patient arrives for his or her appointment, you have the option to check that patient in on the schedule. This can be done by right-clicking on the appointment, then selecting Check-In from the menu.
When this option is chosen, the display color of the appointment will indicate the patient has arrived at the office and is ready for the appointment. The Check-In feature also allows you to collect the patient’s co-pay (if applicable).
Cancelling an Appointment
Once an appointment has been scheduled, you have the option of cancelling the appointment. This can be done by right-clicking on the appointment, then selecting cancel from the menu.
User’s Guide – Patterson PTOS 5.6 Scheduling
61
After selecting cancel, you will have the option to make a comment on why the appointment was cancelled. On the bottom of this screen there will be a list of the patient’s upcoming appointments so you can remind the patient of his or her next appointment. The option to view the waitlist is also here. This will allow you to see if there are any appointments in the waitlist that you can call on to fill your schedule.
No-Show Appointments
If a patient does not show up for their appointment, you can mark the appointment as a No-Show. This can be done by rightclicking on the appointment, then selecting No-Show from the menu.
Like cancelled appointments, when No-Show is chosen, you will have the option to make a comment about the No-Show appointment and view the waitlist if necessary.
User’s Guide – Patterson PTOS 5.6 Scheduling
62
Reschedule
Reschedule an appointment, select the existing appointment.
From the right-click menu, select Reschedule. Select the desired appointment time and date. Appointments and Blocks can also be rescheduled by dragging or cutting and pasting.
Voiding an Appointment
If an appointment is created for the wrong patient, it can be voided from the schedule. This can be done by right-clicking on the appointment, then selecting Appointment Void from the menu.
The Appointment Status window appears. Enter a Comment to this appointment void, if applicable.
Select the View Waitlist checkbox to launch the Waitlist after voiding. This will allow you to see if there are any appointments in the waitlist that you can call on to fill your schedule.
Select Ok to void this appointment. Select Cancel to exit without voiding.
User’s Guide – Patterson PTOS 5.6 Scheduling
63
Additional Right-Click Options
Collect Co-Pay
If the patient’s co-pay was not collected at the time of Check-In, it can be collected at a later time using the Collect Co-Pay. To access the Collect Co-Pay option, right-click on the appointment and choose Collect Co-Pay option from the menu. The following window appears.
User’s Guide – Patterson PTOS 5.6 Scheduling
64
In the Co-Pay window, select the applicable co-pay. Use the drop-down menu to select the Payment Type and Facility ID.
Select Collect Co-Pay to complete the transaction. Select
Cancel to exit without collecting.
Select the Co-Pay History button to view a list of past co-pay payments for the selected patient.
Based upon your individual config settings, the Enter
Charges window may appear.
Enter Charges
The Enter Charges feature allows you to complete a charge ticket for this appointment. To access the Enter Charges feature, rightclick on the appointment and choose Enter Charges from the menu.
This will open the Charge Ticket area. Simply select the appropriate charges for this appointment and then click OK to complete the Charge Ticket.
Select Cancel to exit without applying a Charge.
Select the Audit Charges button to check for warnings that have been attached to the selected C.P.T. code. Select the checkbox
Filter C.P.T. Codes to filter out any addition codes from the list.
To sort this list by column headings, select the name of the column. All columns can be sorted.
Select the Filter C.P.T. Codes checkbox to remove the C.P.T.
Codes from the list.
Select the Additional Codes tab to access your office’s additional non-billable codes.
To enter a charge, select the corresponding checkbox in the
Select column. Select OK.
User’s Guide – Patterson PTOS 5.6 Scheduling
65
Note Complete
The Note Complete feature allows for the Scheduling and
Documentation modules to communicate. To link an existing note to a new appointment, right-click on the appointment and select, Note Complete. This will associate the note with the appointment in the Worklist.
Copy
Use this option to copy the selected appointment.
Cut
Use this option to cut the selected appointment.
Paste
Use this option to paste the selected appointment onto the schedule.
Patient Editor
The Patient Editor feature allows access to the patient information without ever leaving the schedule.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Print Appointment Card
This option can be used to print a full-page appointment card for your patient. The Appointment Card includes the Appointment
Date, Facility ID, Start Time, Appointment Type as well as the
Therapist he or she will be seeing.
User’s Guide – Patterson PTOS 5.6 Scheduling
66
Print Superbill
This option allows your office to print off a checklist including all the charges that may be billed to a patient. This can be filled out and then that information can be used to assist in filling out a
Charge Ticket for your patient’s appointment.
Schedule Calendar View
Schedule Views
There are different schedule views that can be used for the schedule. The Daily View shows all appointments at your facility for the selected day.
Further filter the view by Facility, Therapist Group and
Resource Group.
The Weekly View allows you to see the weekly schedule for a single therapist or resource at your facility.
S
how CXL/NS Appointments
This checkbox allows you to control whether you would like to see appointments that have been marked as cancelled or no-show appointments. This option can be toggled on/off at any time.
User’s Guide – Patterson PTOS 5.6 Scheduling
67
Send Email Reminder
This option allows you to send appointment reminders via email.
If this option is selected, an email information box will appear showing the Total Appointments, how many have email addresses set up and the amount of emails to be sent now. You will then have an option to send out the reminders.
Print Preview
This option allows you to preview the schedule prior to printing. If you need a hard copy of the schedule, you can print it from this area. This option is only available in Calendar view. To access print preview, go to Scheduler, and click the Print Preview button in the upper right of the screen. Select the printer to be used.
Click Ok. Once the printer is chosen, the preview is created.
Print in Color
Selecting the ‘Print in color’ button in the upper right of the screen, will preview and print the schedule in color, otherwise it will preview and print in gray scale. The box is defaulted as 'unchecked'. Once the box is selected, the system will retain the selection going forward.
Schedule Appointments View
Select the Appointments tab to view the schedule by appointment.
In the Appointments view, select to view appointments
Appointment Search.
User’s Guide – Patterson PTOS 5.6 Scheduling
68
The Appointment Search View allows you to see the available time for your therapists. Further filter this view by Facility,
Therapist and Resource.
Enter the Appt Duration time and select the Time of Day to further narrow the search for an available appointment time.
Select the Show Block/Holds checkbox to include that information in the Appointment Search.
Transfer Appointment
Under Scheduling
Transfer Appointment, move appointments between rooms.
Select the Source Therapist, Start Date, End Date and
Destination Therapist. Select the Refresh button. Select an
User’s Guide – Patterson PTOS 5.6 Scheduling
69
Waitlist
appointment using the checkbox Select or select the Select All checkbox. Select the Transfer button to move appointments.
To schedule an appointment using the Waitlist, select
Scheduling
Waitlist.
In the Waitlist, narrow your list by selecting the Facility, Time of
Day, Therapist, Resource, Appt Type and Waitlist Dates. To schedule a Waitlist patient, check the Select checkbox and select
Add Appointment. To remove a patient from the Waitlist, check the select box and select Remove from Waitlist. Select Close to exit.
Appointment / Block Void
To use the Appointment / Block Void, select Scheduling
Appointment / Block Void. Enter a patient and select Enter.
Select the desired appointment and select Void. In the Multiple
Status Comment, enter a comment if desired. Select OK to void the appointment.
The following screen appears.
User’s Guide – Patterson PTOS 5.6 Scheduling
70
Select OK.
Voiding Blocks
To Void a Block, leave the Patient Name and Patient Acct# fields blank. Select the Therapist desired or leave as Any Therapist.
Select the Resource, Start Date and End Date desired. Select
Fetch to retrieve data. Select the desired Block and select Void.
Enter a comment (optional) and select OK to Void.
User’s Guide – Patterson PTOS 5.6 Scheduling
71
Documentation
Template Admin
Use the Template Admin to create customized correspondence.
Go to Documentation | Template Admin. Select the headings on the Information tree to open additional screens. The following is example of the Patient Questionnaire template.
In the Note Type, select from the available options in the dropdown list.
Header
Header information includes the following items:
DOB
SSN
Phone/Fax
Referred By
Phone Insurance Authorization/Claim #
Therapist Date of Service
PCP Diagnosis
Injured Date Initial Evaluation Date Total Visits/CXL/NS
User’s Guide – Patterson PTOS 5.6 Documentation
72
Additional Options
Select the Link to Appointment checkbox to tie the selected template to patient appointments.
Select the Close Note Charge Ticket to display the Charge
Ticket when the selected note is closed
Select the Inactive checkbox to inactivate the selected note.
Comments are not required for a printout.
Edit Template
To edit an existing template, select the Edit icon. This will allow you to make the following changes:
Paragraph Status
Use the drop-down menu to select the Paragraph Status.
Hide Paragraph – Select this option to hide the selected paragraph.
Show Paragraph – Select this option to show the selected paragraph.
Include by Default – Select this option to include the selected paragraph by default.
Required to close Note – Use this option to require paragraph completion prior to closing.
User’s Guide – Patterson PTOS 5.6 Documentation
73
Show/Hide Detail
To remove or display individual lines from paragraph information, select the Show/Hide Detail button.
Pick Lists
In the Show/Hide Paragraph Details window, deselect the Show checkbox to hide the line item from the paragraph. Select OK to save.
Copy from Note
To include information from other Notes, select Copy from Note and select the note from which to pull the information.
To access Pick Lists, select Documentation
Change Pick List.
The other is to right-click in the yellow areas of patient chart. Use
Pick Lists to enter pre-created information throughout the note.
1. Right-click on the yellow field and a Pick List appears.
This example is a single select pick list indicating that only one of the items can be selected from the list.
2. Once an item is selected it will be entered into the note.
In addition to single select pick lists, there are multiple select pick lists, which allow you to choose one or more items to be entered into the note. In the yellow highlighted areas, it is not a
User’s Guide – Patterson PTOS 5.6 Documentation
74
requirement to use the pick lists, the option to free form type is available.
Patient Chart
The first step to creating notes is to open up a patient’s chart. You can access patients’ charts by selecting Patient Chart at the top of your screen or by going to Documentation
Patient Chart.
User’s Guide – Patterson PTOS 5.6
Select the desired patient from the Patient Search window.
Creating a New Note
To create a new note, select the Add Note icon or select the F2 key.
Documentation
75
Choose the Note Type you wish to create from the dropdown menu. Verify that the Date of Service is correct and select OK to create the note. For this example, we will use the Progress/Daily
Notes.
To create a new note based upon existing information, select Copy from existing
note. Use the drop-down to select the desired note.
Select the Date of Service and select OK to continue.
You can also double-click on a paragraph to remove it.
Add attachments to a note by selecting the Attachments tab. Select the Browse button to locate the file. Enter a
Description and date if necessary. Select OK to attach the file to the current note.
The Initial Evaluation note will now populate the screen. Along the left side of your screen is a display of the different paragraphs that can be included in the Initial Evaluation note. The paragraphs displayed in purple are the ones that are included in the Initial
Evaluation note by default. The option to include the gray paragraphs is available by right-clicking on the paragraph and selecting Add Paragraph or double-clicking the paragraph. In addition, any paragraph that is included by default can be removed by right-clicking on the paragraph and select Remove
Paragraph.
The Header of the note will be populated with the patient’s information already entered into the system. This information can be edited here if needed.
Saving a Note
Notes may be automatically saved as you add to or make changes to a note.
Edit and/or enhance the pre-written narratives in PTOS notes. In
Documentation | Template Admin, select the Note Type from
User’s Guide – Patterson PTOS 5.6 Documentation
76
the drop-down menu. The following paragraph templates can be modified:
Short/Long Term Goals
Edit Paragraph
Details
In Template Admin, select one of the editable Note Types from drop-down list. The editable Note Types are:
Re-Evaluation
Cancel/No-Show
Discharge Summary – Brief
PTPN Initial Evaluation Report
PTPN Initial Evaluation Letter
PTPN Progress/Daily Notes
In the Paragraph Description list, select the desired description.
Select the Edit (F3) icon to place the template in Edit mode. Next, select the Edit Paragraph Details button. The following window appears:
User’s Guide – Patterson PTOS 5.6 Documentation
77
The last changes made to the
Paragraph Details will become the default.
In the Edit Paragraph Details window, select the name of the detail that you wish to edit.
Select the Show checkbox to display the detail on your template.
Deselect the Show checkbox to hide the detail.
Ten additional blank lines are also available at the bottom of each narrative. In the Edit Paragraph Details, select the Show checkbox next to the blank lines to add them to the templates.
Select OK to save your changes.
Comparing Initial Evaluation with Re-Evaluation
PTOS Documentation has the ability to compare Initial
Evaluations and Re-Evaluation on a single note. You have the ability to compare up to three notes on a single page (i.e. Initial
Evaluation, and two Re-Evaluations). Once the Initial Evaluation has been created, a new note needs to be created. Choose Re-
Evaluation as the Note Type for the new note. After clicking OK, the option to compare the note to an existing note becomes available.
Choose the note(s) that you wish to compare and then click OK.
The new document comparing the notes will now populate your
User’s Guide – Patterson PTOS 5.6 Documentation
78
screen. Fill in the appropriate information in the Re-Evaluation column and save the document.
Note History
The Note History allows you to view all existing notes for this patient. This includes all open, closed and voided notes and attachments for the individual patient.
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Open Note Options
Right-clicking on a note in the Note History area opens up a menu of options pertaining to the individual note.
User’s Guide – Patterson PTOS 5.6 Documentation
79
Preview
This option opens up a print preview of the selected note. This allows you to see what the note will look like when printed.
This option prints the selected note.
Editing Using PTOS Editor
This option opens the selected note so additions/changes can be made. You can also double-click the note in the Note History to open it in the PTOS Editor.
Sign
This option allows for several actions to take place. When selected, the first screen that will appear is the Charge Ticket screen. The ticket can be filled out at this time or you can use cancel if you wish to fill it out at a later time. The next screen is the Sign Note screen. The first step is selecting the appropriate
Date of Service and Therapist. Next, if you wish to close the note, the Primary Therapist box will need to be checked. The selected therapist will then be required to type in his/her password.
Select OK and the note will now be signed and closed. Once a note is closed, it will now move into the closed category under the
Note History.
Void
If a note is mistakenly created, the option to Void the note is available. All voided notes stay in the patient chart but cannot be edited once they have been voided. Right-click on voided notes to print or preview.
User’s Guide – Patterson PTOS 5.6 Documentation
80
Charge Ticket
This will open the Charge Ticket screen. Simply select the appropriate charges for this note and then select OK to complete the Charge Ticket.
Edit Using Microsoft Word
Use this option to edit a note outside of PTOS. Once a note has been edited in MS Word, it can no longer be edited in the PTOS
Chart Area.
Closed Note Options
Fax/Email
This option can be used if you are set up with an electronic fax company or are using a MAPI (Messaging Application
Programming Interface) compliant email program.
Re-Open
This option allows the note to be opened and edited. It is only available until midnight of the day the note was signed.
Add Addendum
If a note is closed and it can no longer be reopened, information can be added to the note using the Add Addendum feature. It opens a free-form text field where additional notes can be entered.
User’s Guide – Patterson PTOS 5.6 Documentation
81
Link Note to Appointment
If you have purchased both the Scheduling and Documentation modules, you have the ability to link notes to appointments. Once an appointment is on the schedule, you have the ability to link a note from the Patient Chart to that appointment.
Review
This area allows you to compare paragraphs from multiple notes.
For example, if there are three Daily/Progress Notes for a patient, you can select which paragraph from those notes you would like to compare. Choose which notes you would like to compare by checking the box on the left, then choose the paragraph you would like to compare at the bottom.
The paragraphs will then be compared on a single, printable page.
Facility Logo
Under Special Tasks | Add/Update Client Logo you can customize notes by adding your facility’s logo. In this screen you can Add/Update or remove a logo from your notes. Select the
Add/Update Client Logo button to browse to the desired image.
User’s Guide – Patterson PTOS 5.6 Documentation
82
Note: Logo size must be
120 x 120 pixels.
User’s Guide – Patterson PTOS 5.6 Documentation
83
Billing
Transactions
NOTE: If you are still using PTOS Billing 3.5, please refer to your PTOS 3.5 manual for information pertaining to the Billing module and its functions.
PTOS 5.0 Billing handles all transactions for patients, such as charges, payments, adjustments, outstanding balances, and other important financial information.
Transactions entries affect an account balance.
Enter Charges
See the Glossary of Terms located at the back of this manual for more information
on terminology.
The boxes at the top of the case display read only information that defaults from Patient Editor for the Patient name displayed in the posting line. The upper portion of the window contains numerous fields:
User’s Guide – Patterson PTOS 5.6 Billing
84
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Patient # – The Patient ID number
Name – Patient Name
Case # – Case Number
Authorized (date) – Authorized dates for service
Visits – Number of visits completed
Allowed – Number of visits authorized
Remaining – The difference between Visits and Allowed
Discipline – The required discipline
Acct. Type – The patient account type
Post Note – Any available notes
Charge Limit – The authorized charge amount per visit
Charge per Day – The amount of charge authorized per day
Primary DX, DX-2, DX-3, DX4 – Diagnosis codes applicable
Charges are entered in this order:
Date – The Date automatically defaults to the login date, but the user can edit the date. Once the date is edited, subsequent lines default to the new date. A date in the future can also be entered. (This field is required)
Patient Name – When accessed from Patient Editor or
Scheduler, the current patient appears automatically. If accessed anywhere else in the system, the field is blank and Patient information must be entered manually. (This field is required)
In the posting line, enter the first few letters of the patient’s last name, or % in the Patient Name field and select the
Enter or Tab key to enter the Patient Search window to select a patient. Select the X and proceed as above to display the Patient Search window.
A Grand Total of All Charges for all patients in this charge window appears at the top of the window.
User’s Guide – Patterson PTOS 5.6 Billing
85
If no Therapist is set up, choose a therapist by selecting the dropdown arrow.
Entering Billing information
C.P.T. Code – Enter a C.P.T. code into the patient’s record by any of these three ways:
1. Type the C.P.T. code into the C.P.T. code field.
2. To find the closest match to the code you want, activate the C.P.T. Code Search window by typing the first few characters into the field and pressing Enter.
3. Type the percent (%) sign into the field to bring up the
C.P.T. Code Search window.
Units – Enter the number of units. Units will default to this window from C.P.T. Code setup. This field is editable.
Chg Amt – This number is generated from the C.P.T. code or Fee
Schedule and cannot be edited.
Allow Amt – This number is generated from the C.P.T. code or
Fee Schedule and cannot be edited.
Modifier – The default for this field is from C.P.T. Code Setup. It can also default from Fee Schedule, which would override what was entered during C.P.T. Code Setup. The limit is 4 modifiers.
Modifiers can be edited from the Billing window.
Description – Defaulted from C.P.T. Code Setup or from the
ICODE entry.
PT – Click on the drop-down arrow to select the PT who provided the service. If the patient has an Assigned Therapist, that name will default into this field. A Therapist set in an Appointment has precedence over an assigned therapist.
DX – Select which diagnosis is appropriate for this service. The default DX set in Patient Editor displays and can be edited. A maximum of four (4) DXs can be displayed.
Co-pay – Defaults from what was entered in the Patient Editor.
If Co-pay was entered in Scheduler, it overrides any other co-pay
User’s Guide – Patterson PTOS 5.6 Billing
86
amounts entered elsewhere in the system. If co-pay is not entered through Scheduler, then co-pay defaults from the Patient
Editor Bill Tab. If the Bill Tab is blank, then it would default as 0
(zero) on the enter charges. Co-pay can be manually entered but defaults to codes that are marked to affect visits.
Visit – The default is checked anytime there is not an existing
Visit marked for each DOS for a patient unless the C.P.T. code was not designated to count as a visit in code setup. A visit is not required to post charges. If you manually change the Visit box, the system will not override this value unless the patient date of service is changed.
Bill To – Designates which party you are billing for the charges about to be entered. It defaults to primary insurance, unless something different is specified in the C.P.T. code, which would then take precedence. It can be modified. If no insurance is listed for the patient, it should default to Bill to Patient Responsibility.
Click on the drop-down arrow to select who will receive the bill for services provided to the patient.
Facility – Click on the drop-down arrow to select the physical office or treatment center where medical services were provided to the patient. The default for this field is from Scheduler. If nothing is set in Scheduler, then use the assigned facility for the selected case in Patient Editor. If the assigned Facility field is blank, it should default to the Primary Facility that was assigned in Patient Editor.
POS (Place of Service) – Defaults from the HCFA/UB04 Tab in
Patient Editor. If the Patient Editor POS is blank, then the POS during charge entry will default from the Account Type, if there is one attached.
Rev – Can be assigned if one applies to this charge. The default is what was set in C.P.T. Code Setup or Fee Schedule. If it remains blank, nothing is selected.
ICODE – An ICODE can be used in place of a C.P.T. code by typing an ‘I’ in the C.P.T. code field. An ICODE Charges box displays. ICODES are used as ‘placeholders’ for codes that are not currently available in the system. ICODE will default to Y
(Yes) as a Visit. Deselect if you would like to remove and count as N (No).
ICode checkbox – Box is automatically checked to designate when an ICODE is created. It is defaulted to be check marked when an ICODE is used in the C.P.T. Code box. This box cannot be modified.
Charges entered from the Enter Charges window are automatically approved. Charges entered from Documentation and/or Scheduling through the Charge Ticket will remain
Unapproved. User can edit and then Approve these charges.
User’s Guide – Patterson PTOS 5.6 Billing
87
Boxes across mid section of page are separated into three groups that define the following information for the chosen patient:
Group 1 — Previous Patient Balance (excludes current charges)
* Case Balance: Same as Balance on Transaction
Summary. Case Balance is the total balance per case.
Current charge entry is not included in this total.
* Ins. Balance: Total of Primary/Secondary and Tertiary balances from Transaction Summary screen or calculated as the Charge Amount – Deductible - Co-pay – Co-
Insurance.
* Patient Balance: Should correlate with Patient Balance on
Transaction Summary screen; calculated as the Co-pay +
Co-Insurance (minus current charge entry) + Deductible.
Group 2 — Case Information (includes current charges)
* Last Visit: Date of last charge on Transaction Hx screen.
* Last Code: last procedure from the last date of charge posted in Transaction Hx screen.
* Fee Schedule: Pulls first from Patient Editor (Patient
Case) and then from Insurance Company setup. This will also reflect any changes made manually on the current charge.
* Max. Units per Day: Data obtained from Patient
Editor/Billing tab.
Group 3 — Today’s Charges (includes current charges)
Deductible).
Total Charges This Patient – Total of all charges posted for this patient.
User’s Guide – Patterson PTOS 5.6 Billing
88
Other Enter Charges Features
Cogwheel icon: If charges are already entered, these options are immediately available: Patient Editor, Charge
Ticket, and Last Visit.
Patient Editor: The main location in PTOS 5.0 where you can Add, Edit and/or View patient data in the system.
Charge Ticket: Select this option to take you directly to the Charge Ticket to enter charges.
Last Visit: A quick way to post recurrent charges to patient cases(s). If the patient has been treated previously at this facility, the information from the last visit defaults. This feature is disabled on new patients.
Charge Ticket
A Charge Ticket can be accessed from Scheduling and/or
Documentation with the same functionality in all areas. In
Scheduling, right-click on an appointment and select Enter
Charges.
The Charge Ticket allows you to:
Select charges for a specific Date of Service
Audit Charges
Filter Procedure Codes for Fee Schedule
Once you select charges from the Charge Ticket and click Ok, the charges are held as Unapproved.
When a Charge Ticket or Superbill is displayed for a particular patient, it is more efficient to show only the Fee Schedule codes
User’s Guide – Patterson PTOS 5.6 Billing
89
that apply to that payer. If there are Fee Schedule codes, the default will be marked to filter; otherwise, all codes will show.
At the top of the Charge Ticket, a non-editable date field displays today’s date.
A separate area on the Charge Ticket includes all codes marked specifically to include in this additional area (per C.P.T. CODE setup. Codes displaying on the main area of the Charge Ticket will be those marked to display on the main area of the Charge
Ticket per C.P.T. CODE setup.)
Appointment Warning Messages
You should get Warning Messages in Enter Charges and
Charge Ticket under the following circumstances:
The date of the proposed service is after the Authorized
Expiration Date for the Patient/Case(s).
If the number of charges entered and marked as visits for the Patient/Case(s) exceeds the authorized Visit limit for the Patient/Case(s).
Max number of Units is exceeded.
Charge per day is exceeded.
Additional warnings that can be set include:
Charge limit warning based on Charged amount or Allowed
Config Parameter to be warned when you are within a
$XXX.XX specified amount of the limit.
Charge Limit Warning
Charge limits will automatically reset according to the effective date entered for the period. To access Charge Limit, go to
Patient Editor | Bill tab. It is located in the upper right hand of the screen.
User’s Guide – Patterson PTOS 5.6 Billing
90
Payments/Adjustments
Keyboard Shortcuts
F2 – Use this key to Add a new item in a list.
F3 – Use this key to Edit an existing item in a list.
F5 – Use this key to search an existing list.
% – Use this key in a search field to open the entire list of options.
Account Payment
To make Account Payments, select Billing
Payments /
Adjustments. Toggle between Account Payments, Insurance
Payments and Adjustments using the tabs on the left side of the window.
In the Payment Information section, select the Payment Date if not already apparent. Select the Facility. Use the Payment
Type drop-down list to select the type of payment being made.
Enter the Check/Bank/Authorization number pertaining to the payment type. Enter the Amount of the payment. The Account
Type appears by default.
To apply the payment to Unapplied Payments, select the
Unapplied Payments drop arrow and select the transaction.
Enter a Comment if desired.
Select the checkbox Print Payment Receipt to create a receipt for this payment.
Select Automatic Distribution or Manual Distribution to distribute payment. Selecting Manual Distribution allows you to enter the amounts to the desired transactions. Automatic
Distribution pays to charges with co-pay owed first and then to the oldest Patient balance.
User’s Guide – Patterson PTOS 5.6 Billing
91
Insurance Payments
To make Insurance Payments, select Billing
Payment /
Adjustments. Toggle between Account Payments, Insurance
Payments and Adjustments using the tabs on the left side of the window.
Select the Insurance Payment tab to make Insurance payments.
In the Payment Information area, use the drop-down list to select the Payment Date. Select the desired Facility. Review the
Account Type and select the Payment Type. Enter the Amount of the payment and make any necessary comments. Mark Final
Payment if applicable. Select the Print Payment Receipt to create a receipt.
Select Automatic Distribution or Manual Distribution to disperse payment. Manual Distribution allows you to enter the payments and amounts as you like.
In the Open Claims area, sort by the following columns:
Patients
Create Date Claim Notes Insurance
Name
Claim Amt.
Adj. Amt
Exp. Ins.
Adj Details
Ins. Pd Ins. Type
Select the Edit Filter hyperlink to filter and narrow the payment history by a specific date range. Use the drop-down arrows to select the filter dates and select Apply Filter. To return the view to show all transactions, select Reset Filter.
Payment information appears at the bottom of this screen.
Posting Payments-Multiple Users
Multi-User functionality provided for users posting payments simultaneously in various payment windows. Multiple users can
User’s Guide – Patterson PTOS 5.6 Billing
92
post payments at the same time. The user may get a warning if trying to post something at the exact same time as another user.
The system will stop one of them.
Adjustments
To make Adjustments, select Billing
Payments / Adjustments.
Toggle between those options using the tabs on the side of the window.
Select the Adjustment Tab to make adjustments to a patient’s account. In the Adjustment Information area, use the dropdown list to select the Adj. Date. Select the Adj. Type and review the Acct. Type. Select the desired Facility. Select either Credit
Adjustment or Debit Adjustment. Enter any applicable comments in the Comments field. Enter the Amount of the payment.
Select Automatic Distribution or Manual Distribution to disperse payment. Manual Distribution allows you to enter the payments and amounts as you like.
Unapplied Payments are payments or adjustments that have been made but not attached to transactions.
Default Adjustment Group and Reason Code
The default Adjustment Group Code and Reason Code will now default when using the Auto Adjust feature in Config Parameters.
1) To set the Auto Adjust feature go to System Tasks |
Supervisor | Config Parameters. On the upper righthand-side select Billing. In the lower table select Billing |
User’s Guide – Patterson PTOS 5.6 Billing
93
Auto Adjust | Yes. Select Edit to change the appropriate value of Yes or No.
2) To set the default Adjustment Group Code and Reason
Code, go to Billing | Insurance Billing | eClaims Setup tab.
The eClaims Provider must be set to Emdeon
®
. This feature is NOT available to those using ‘Other’ clearinghouses. To the right there are two drop-down fields. This is where the Default Adjustment Group Code and Default Adjustment Reason Code are set. Click Save.
User’s Guide – Patterson PTOS 5.6
3) Now when making adjustments through the Insurance
Payments and/or Bulk Payment windows, these codes and adjustment amounts will be defaulted. The user can change the defaults if necessary, or simply save the payment if all the defaults are correct.
Billing
94
Insurance Payment Windows
Payments with an amount greater than the balance can now be made in both the bulk and regular insurance payment windows.
Visual indicators have been added to warn you when an overpayment is applied.
In the top grid, the Ins Pd Amt field turns orange with a tooltip to indicate any previous overpayments already saved for that claim.
In the bottom grid, the Pay Amt field turns orange with a tooltip indicating the overpayment amount for that particular charge. In addition, orange text detailing the overpayment amount appears at the bottom of the window near the distribution fields.
Example: A full insurance payment has been made on a claim where the patient has already made a $20.00 payment. In this case, the $20.00 patient payment is moved to unapplied so that the entire $100.00 insurance payment can be distributed to the claim.
X-Charge Electronic Payment Processing
To sign up for X-Charge Electronic Payment Processing services, contact our eServices team at 800.824.4305 to enroll.
Introducing X-Charge - a complete electronic payment processing system that is now fully integrated with PTOS 5.6.
To create a patient refund or other debit adjustment, selec the
Adjustments tab. Under Merchant Payment, select the dropdown arrow to use either the Credit, Debit or E-Check radio button.
User’s Guide – Patterson PTOS 5.6 Billing
95
To collect an X-Charge Co-pay payment from the Schedule, right-click and select Collect Co-Pay.
User’s Guide – Patterson PTOS 5.6
In the Co-Pay window, select the payment type and Merchant
Payment information. Use your card reader as directed and follow the prompts. Select the Collect Co-Pay button to complete the transaction.
Billing
96
System Voids on Overpayments
In order to make automatic entries easier to locate on reports, these overpayments will now display with the same date as the original transaction.
Note: Any transactions that you void from the cogwheel will still post on the date in which the void was made based.
For example: Patient A comes in for treatment on 8/01/12.
That treatment adds up to $100.
The patient pays $50 on 8/01/12 toward that treatment.
Insurance then sends a check on 8/15/12 for the full $100.
The system will post the $100 insurance check to the services.
The $50 patient payment will get moved to unapplied.
The $50 unapplied patient payment AND the system Void will be posted on 8/01/12.
Note: We also recommend that you do NOT backdate PTOS from the login screen to make it easier to find any voids or re-entries that you made in your system.
Patient Transactions
Summary Tab
Select Patient Transactions under Billing
Patient
Transactions. In the Summary tab, review a quick overview of a selected account.
User’s Guide – Patterson PTOS 5.6 Billing
97
Select a patient by using the patient search. Under Case
Description, select the desired case from the drop-down list.
Review the Location.
Under Activity, review Ins Unbilled, Charges, Payments,
Adjustments, Last Date Ins Billed, Last Date Pat Billed,
Last Code and Last Code Date.
Under Visit Limitations, review First Visit Date,
Authorization Expiration Date, Authorized Visits,
Actual Visits, Remaining Visits and Charge Limits.
Under Balance, review the Current, 30-59, 60-89, 90-119
and 120+ balances, Expected Primary Ins Bal,
Expected 2 nd
/Tertiary Ins Bal and Patient Balance.
Under Unapplied, review the Unapplied Balance.
Use the Cogwheel to access an additional menu.
Cogwheel
Select the Cogwheel icon in the upper right corner to access an additional menu. Through Cogwheel, you can access:
Patient Editor – Open the Patient Editor for the selected patient.
Bill Patient Now – Generate a patient statement.
Bill Insurance Now – Generate a patient claim.
Recreate Claims – Recreate a closed claim for the selected patient.
Void Transaction – Nullify the selected transaction.
Modify Transaction – Edit the selected transaction.
Payments/Adjustments – Access the
Payments/Adjustments window.
User’s Guide – Patterson PTOS 5.6 Billing
98
Enter Charges – Enter charges to the patient’s account.
Overpayments - Patient Transactions
An icon displays in the transaction history screen next to any charge that has an overpayment. A tooltip on the icon also displays the overpayment amount when you hover your computer mouse over the icon.
When a charge with an overpayment is highlighted in the top grid, the detail grid at the bottom of the window shows any overpaid amounts with the text OVERPAYMENT in front of the description.
These OVERPAYMENT amounts are no longer applied to the charge.
Example: The unapplied $20.00 patient payment becomes an unapplied overpayment amount.
When a credit that was fully or partially moved to an unapplied overpayment is highlighted in the top grid, the detail grid at the bottom of the window shows the service code and the date of service the credit was removed from.
User’s Guide – Patterson PTOS 5.6 Billing
99
Example: The now unapplied $20.00 patient payment shows that it was once paid on the
PT EVALUATION charge.
History Tab
Select the History tab to view patient transactions by date. This screen is a more detailed overview of the patient account including:
Date – The date of the transaction
Code – The code billed on the transaction date
Description – The description of the code
TranType – The transaction type
Amount – The price attached to the code
User’s Guide – Patterson PTOS 5.6 Billing
100
Allow Amount – The amount expected to be paid by the insurance company attached
Diff Between Chg/Allowed Amt –The difference between the amount charged and the amount allowed by insurance
Co-pay – The patient’s co-pay amount
Expected Ins – The patient’s expected insurance amount
Insurance Paid – The amount paid by the insurance company
Patient Paid – The amount paid by the patient
Adjustments – Any adjustments that have been applied
Balance – The current balance of the case
AT – Account Type
PT – Therapist
Visit – Identifies appointments that qualify as visits
Unit – The number of units
DX – Diagnosis
Facility – The name of the treating facility
POS – Place of Service
Status – The current account condition
Modifier – Modifier
Claim # – The number associated with the claim
User – The person responsible for making entries.
Edit date – The date that edits were made to the transaction
Select the checkbox Show Void Transactions to include voided information in the transaction history.
Select the PTOS 3.6 Transactions button to view an overview of transactions from the previous version of PTOS.
Select the Transaction Audit Trail button to view a report of transactions for the selected account.
Use the Legends drop-down arrow to identify the color code for each transaction type.
Selecting a transaction from the upper pane displays details in the lower pane. To edit a line item, double-click and modify the information on the right.
User’s Guide – Patterson PTOS 5.6 Billing
101
Use the Cogwheel to access a menu of options. See the above section for more information on the cogwheel menu.
Daily Transactions (Charges)
A window will be available where you can approve charges entered in Charge Ticket within the system to post entered charges to patients’ accounts. Once the charges are approved, they are ready for insurance and/or patient billing. Also, when accessed from Billing
Daily Transactions, you can see different
Transaction Types: Approved Charges, UnApproved Charges,
Payments, and Adjustments.
Approved Charges
After selecting the Transaction Type Approved Charges, select the Facility ID, Entry User, Patient Name, Status and
Therapist. Select the desired Date of Service. Select Refresh.
Use the Cogwheel to access an additional menu of options.
User’s Guide – Patterson PTOS 5.6 Billing
102
Cogwheel
Daily Transactions Report – Select this option to generate the
Daily Transactions report.
Void Transaction – Nullify the selected transaction.
Modify Transaction – Edit the selected transaction.
Patient Editor – Open the Patient Editor for the selected patient.
Bill Patient Now – Generate a patient statement.
Bill Insurance Now – Generate a patient claim.
Enter Charges – Enter charges to the patient’s account.
Payments/Adjustments – Access the Payments/Adjustments window.
UnApproved
User’s Guide – Patterson PTOS 5.6 Billing
103
After selecting the Transaction Type UnApproved Charges, select the Facility ID, Entry User, Patient Name, Status and
Therapist. Select the desired Date of Service. Select Refresh.
Use the Select All checkbox to select all available transactions.
To approve a charge, select the Approve button.
Use the Cogwheel to access an additional menu of options. See
Approved Charges for more information on the Cogwheel options.
Payment
After selecting the Transaction Type Payments, select the
Facility ID, Entry User, Patient Name, Status and Therapist.
Select the desired Date of Service. Select Refresh to update the transaction screen. In the Payment Details area, enter Charge and Pay/Adjusts desired for the selected transaction.
Use the Cogwheel to access an additional menu of options. See
Approved Charges for more information on the Cogwheel options.
User’s Guide – Patterson PTOS 5.6 Billing
104
Adjustment
For More Information on CCI and LCD data, go to www.cms.hhs.gov.
After selecting the Transaction Type Adjustments, select the
Facility ID, Entry User, Patient Name, Status and Therapist.
Select the desired Date of Service. Select Refresh to update the transaction screen. In the Adjustment Details area, enter
Charge and Pay/Adjusts desired for the selected transaction.
In the Date of Service area, today’s date defaults as the Entry
From and To dates. You can leave all filters blank with only a date range specified and Refresh.
Double-click on a charge to edit it. A message will be included to run CCI /LCD AUDITS (if this option has been setup in Config
Parameters).
Charges are now ready for Insurance and/or Patient Billing.
Accounts Receivable is automatically updated.
A different Cogwheel icon Menu is available from this window:
Daily Transaction Report, Audit Codes, Void Transaction,
Modify transactions, Patient Editor, Bill Patient Now, Bill
Insurance Now, Enter Charges, and Payments/Adjustments.
Charges created from the Enter Charges screen will be automatically approved.
Use the Cogwheel to access an additional menu of options. See
Approved Charges for more information on the Cogwheel options.
CCI/LCD Audits
During the Approve Charges process outlined above, you have the option to run CCI/LCD Audits. The CCI Audits are updated quarterly by CMS. LCD Audits are determined locally by financial intermediaries. Multiple CCI or LCD Audits can be set up and
User’s Guide – Patterson PTOS 5.6 Billing
105
attach to the Account Type and the insurance company. This allows the system to handle different allowances for states, regions, etc.
CCI Audits
In the Cogwheel, select Audit Codes. This audit looks for conflicting C.P.T. codes that should not be billed together and gives you the opportunity to edit the charge and/or add a
Modifier.
LCD Audit
LCD Audits can be run simultaneously with the CCI Audit. The
LCD Audit is a check to ensure that C.P.T. codes and DX codes are payable when billed together. If there is a conflict, the audit will warn you that the C.P.T. Code will not be paid with that DX code. You can modify the code from this screen and run the audit again to make sure it passes.
Void a Transaction
Void a transaction that was entered incorrectly by removing the charge. In the Daily Transactions or Patient Transactions screen, select the Void Transaction from the Cogwheel menu
Void a Charge – Select the Charge that needs to be removed and void the entry. AR totals will automatically recalculate based upon this change. Charges that have payments and adjustments posted cannot be voided.
Void an Adjustment – Select the Adjustment that needs to be removed and void the entry. AR totals will automatically recalculate.
Void a Payment – Select the Payment that needs to be removed and void the entry. AR totals will automatically recalculate.
Applying Co-pay
Most patients must pay a Co-pay upon arrival for their appointment. There are two ways to post a Co-pay in the system.
Unapplied Amounts – Select Scheduler on the PTOS
Menu Bar. All appointments with Co-pays will be available and you can pay any amount. Those amounts are considered unapplied amounts. Unapplied amounts can be applied to all transactions. This method is the quickest and easiest way to post the Co-pay and provide the patient with a receipt showing the Co-pay was posted to their account.
Default to Co-Pay – In the Payments/Adjustments tab, make an account payment. Payments will default to pay
Co-Pay first before applying payments to other services.
User’s Guide – Patterson PTOS 5.6 Billing
106
Auto-calculating Accounts Receivable
Accounts Receivable automatically calculates after changes have been made so that all reports and account balances are correct.
Patient Editor Patient Case Acct Type
Patient Editor Bill tab Co-Pay
Billing Patient Transactions Transaction History for
Voiding or Modifying Transactions
Account Aging
Accounts age daily from the Date of Service date in the patient’s account.
Inactive Accounts
When entering transactions for an Inactive patient, a prompt appears allowing you to reactive the selected patient.
Date Range Information
Date range information has been added to the statement billed line in the Transaction History window for each individual statement.
See the following example.
Claims
View Claim status in the Claims window. Select Billing
Claims to view. Select the Facility.
User’s Guide – Patterson PTOS 5.6 Billing
107
In the Claims status view drop-down menu, select from the following options:
Un-Submitted
Note: Claim Notes can only be added to one claim at a time.
InProcess
Open
Rejected
Once you have selected the claim status, mark the desired claims and select from the following options:
Print Image File – Select this option to capture a copy of the electronic claim.
Process – Select this option to submit claims to insurance companies.
Claim Notes – Select this option to add and view notes associated with the selected claim.
Preview – Select this option to preview the selected claim prior to submitting.
Close Claim – Select this option to close the highlighted and selected claims.
Create Additional Claim – Select this option to create another claim based off of the selected claim.
eClaims Reports – Select this option to manually retrieve eclaims reports from the clearinghouse.
Sort columns by selecting the column heading.
Use the quick navigate buttons to launch the following windows:
Patient
Transactions
Insurance
Select Close to exit the Claim window.
Multiple Open Claims
When submitting multiple claims for a particular patient, it is important to note that multiple open claims may have an effect on your patient balance totals. These totals may appear artificially inflated due to the way in which claims are estimated.
Select and Close Multiple Claims from the Claim Queue
Multiple claims may now be closed at one time in the Claim
Queue through Billing | Claims.
User’s Guide – Patterson PTOS 5.6 Billing
108
Check all the claims that are to be closed and click the Close
Claim button. The Closing Insurance Claim window will appear for each claim, prompting the user on how to handle additional insurance or adjustments once the claim is closed.
Close Claim from Patient Editor
When inactivating insurance, if there are outstanding claims for this insurance, the user will be taken to the Claim Queue to close the claims. After reviewing and closing the claims, the user must close the Claim Queue and then will return to the patient insurance window to complete the insurance inactivation. This happens from Patient Editor | Insurance Tab; select insurance and choose the Inactivate button.
Change the Patient’s Insurance, but Leave Current
Claims Open
If Inactivate is selected and there are open claims or unprocessed charges for this insurance, a new warning will appear.
User’s Guide – Patterson PTOS 5.6 Billing
109
‘Yes’ will take you to the claims queue where you can review and close any outstanding claims for this case prior to inactivating the insurance.
‘No’ will continue the insurance inactivation process for this case but will leave outstanding claims in the claims queue.
‘Cancel’ will abort the insurance inactivation process.
Recreate a Claim without having to Submit it for
Processing (Electronic or Print)
When the user chooses to recreate a claim, he/she now has the option to ‘Send to Queue (Open)’. This option is available from the Recreate Claims window. To get to the Recreate Claims window, go to Patient Editor | Cogwheel | Recreate Claims.
This option is for all types of claims (Primary, Secondary, etc.) and will be sent directly to the Claims Queue as ‘Open’ status.
User’s Guide – Patterson PTOS 5.6 Billing
110
Create a New Claim without having to Submit it for
Processing (Electronic or Print)
When the user chooses to create a new claim, there is now the option to Send to Queue (Open). This option is available from three locations, the Insurance Billing Sort Tab (Option #1 - below), from the Close Claim window (Option #2 - below), and from the
Create Additional Claims window (Option #3 - below).
Option #1
Option #2
User’s Guide – Patterson PTOS 5.6 Billing
111
Option #3
HCFA Box 11A-C Secondary Claim
PTOS allows several options for how to populate HCFA boxes 9 and 11A-C. There is also the option that allows the user to print primary insurance information in boxes 11A-C on secondary claims and also provides the option to leave box 9 blank. To set this option, go to System Tasks | Update Lists | Account Types.
Recreate a Secondary Claim without having to Recreate the Primary Claim
Offices may have the need to recreate or reprocess a secondary or additional claim without having the need to first recreate the primary claim. PTOS 5.0 allows users to skip the step of recreating the primary. From the Recreate Claims window, users can highlight the secondary or additional claim and choose to recreate it.
This occurs under Billing | Patient Transactions,
User’s Guide – Patterson PTOS 5.6 Billing
112
then access the Cogwheel to Recreate a Claim. This can also be opened from Patient Editor | Cogwheel | Recreate Claims.
Patient Billing
Under the Billing menu, select Patient Billing to create an individual or batch of billing statements.
In the Bill by Patient Number section, enter individual patient numbers to generate up to six individual statements for patients.
In the Bill Account Type section, select the Account Type checkbox.
In the Bill Range section, select the alphabetic range for patients or manually enter an alphabetic range for selecting patients.
Select Process Now to begin processing Statements.
Select Send to Queue to send the statements to the Statement
Queue.
User’s Guide – Patterson PTOS 5.6 Billing
113
Standard Options
In the Standard Options tab, select your statement options.
Under Billing Options, select Statement Format – Graphical-
Detailed, Detail with Co-pay or Graphical-Summary.
Use the drop-down menu to select from the available Send To options: Patient or Responsible Party. Use the drop-down menu to select the Print Bills In either Alphabetical or Numeric order.
Enter the Amount Due Description if desired. This is a free-form entry field. Anything entered into this field will be printed on statements.
Select the checkbox Include Patient Billed Notes in Account to add the billed notes to the current batch of statements.
Select the checkbox Print header and foother on every page if desired. Leaving this option deselected will print the header on the first page only and the footer on the last page only.
Under Limit Billing to, select from the available options:
Bill only Charges on which Insurance Payments have been made.
Do Not Include any Charges on an Open Claim.
Exclude Inactive case.
Enter the following information for statements if desired:
Patients with Balance Greater than or Equal to: <enter amount>
User’s Guide – Patterson PTOS 5.6 Billing
114
Patients who have not been billed since <select a date from the drop-down list>
No Patient Payments received since <select a date from the drop-down list>
Bill Cases with the Oldest Balance in Range <select from the drop-down list>
Use the drop-down list to select the Facility ID if desired.
In the Bill by Date Ranges section, select the checkboxes:
Include Activity from past 30 days
Include Activity from <select date range>
Bill only if Patient has “Charges” in the Date Range
Specified
In Header options, select from the available remit to options:
Include Client Logo Include Facility
Phone
Include Facility
Name
Include Facility
Fax
Include eMail
Address
Include Referring
Physician
Include Facility
Address
Include Tax ID
Include Employer
Include Office
Hours
Include Date of
Injury
Select the radio button to include the Web
Address, Diagnosis Code or Neither.
In Body options, select from the available options:
Select Include Balance
Forward to include balance information from previous months.
Include Billed Lines Include Payments Include Balance
User’s Guide – Patterson PTOS 5.6 Billing
115
Forward
Include
Adjustments
Show Expected Insurance Balance
Select the Finance Charges button.
Select the Include Finance Charges checkbox to add a finance charge to statements. In the Account Type to Charge area, select the Account Type checkbox to which you wish to apply finance charges or leave blank for all.
In the Description field, enter the name you wish to use for the finance charges. Enter the Percentage to Charge and the
Minimum Finance Charge Amount. Use the drop-down list to select the Aging Category for Charge Accounts Over and select
All or Discharged in the Charge Patients area.
In the Notes section, enter the Note information to be applied to the current batch of statements. Select Include Notes on
Statements to enter a statement note to be applied on all statements.
Under Footer Options, select the checkboxes for Include Aging and/or Include forms of payment accepted. Select the Add
Remittance Override checkbox to allow the patient payments to go to an address other than the facility address.
When you have finished setting up your options, select Process
Now to begin processing this batch of statements. Select Send
to Queue to send this batch of statements to the Statement
Queue. Select Save Current Settings as Default to make the selected options the default settings for statements.
User’s Guide – Patterson PTOS 5.6 Billing
116
The Statement Queue
In the Statement Queue, review statements, remove statements and make changes to statements prior to printing.
Select the Select All checkbox to mark all statements to be processed. Otherwise, select each checkbox individually. Select the Print Audit Trail Report checkbox to create a list of all statements being processed. Select the Preview button to view statements prior to printing. Select Process Now to begin processing statements. Select Cancel to exit the Statement
Queue without processing.
Select the Print Image File checkbox to create an image file to store.
Insurance Billing
Under the Billing menu, select Insurance Billing to create patient insurance claims.
User’s Guide – Patterson PTOS 5.6 Billing
117
Insurance Billing Sort Tab
In the Bill By Account Type section, select the checkbox associated with the type of insurance claim you are billing. Select the Bill only PTPN Accounts checkbox to only bill PTPN cases.
In the Bill by Date Ranges section, use the drop-down arrows to select the From and To dates or leave blank for all dates.
In the Bill For Therapist section, use the drop-down menu to select a therapist. Select Assigned or Treating. Use the dropdown menu to select the Facility ID or leave blank for all facilities.
In the Bill by Discipline section, use the drop-down arrow to select the desired Discipline or leave blank for all disciplines.
In the Bill by Case # section, enter the patient name.
In the Bill Which Charges section, select from the following checkboxes:
All Unpaid Charges
Select the Pre-billing Alert button to apply an alert to the selected
Account Type. Select Send to Queue to batch the selected claims for later submission. Select Process Now to immediately process the claims.
User’s Guide – Patterson PTOS 5.6 Billing
118
Standard Options Tab
In the Standard Options, select the desired claim form to be made available to you throughout PTOS.
In the UB04 Form box, select from the available options:
Summary
In the UB04 Box 39-41 Default drop-down, select the desired default numbers to appear on insurance claims.
Select from the following additional options for all claims:
Include Insurance billed notes in Account
Print Mailing Labels o
Insurance Labels per Line (1,3)
Automatically run Pre-billing Alert
Select the Set as Default Standard Options button to set the selected options to default.
User’s Guide – Patterson PTOS 5.6 Billing
119
Claims Queue Tab
In the Claims Queue, review claims, remove claims and make changes to claims prior to printing. Select from the following status view options:
Un-Submitted – Claims that have not been printed.
Un-Submitted Electronic – Claims that have not been electronically submitted.
InProcess – Claims that have been submitted but submission reports have not yet been downloaded.
Open – Claims that have been submitted and submission reports have been downloaded and are awaiting payment.
Rejected – Claims that have been rejected by the insurance company.
Or use the Select All checkbox at the top of the window.
Once you have selected the desired claim status, select from the following options:
Facility Filter – Select the drop-down menu to select a facility.
Print Image File – Select this option to create a print image file that can be sent to clearinghouse as an electronic claim option.
Process – Select this option to submit claims to insurance companies.
Claim Notes – Select this option to view notes associated with the selected claim.
Preview – Select this option to preview the selected claim prior to submitting.
User’s Guide – Patterson PTOS 5.6 Billing
120
Close Claim – Select this option to close the selected claim.
Create Additional Claim – Select this option to create a new claim for additional insurance companies for the same services without closing the primary claim.
Sort Queue – To sort items in the Queue, select the heading name.
ERA Queue button – Select the ERA Queue button to open the ERA queue (see below)
eClaims Reports – Select this button to open, purge, print or generate reports on the status of eclaims. The following is an example of the eClaims Reports screen.
In the eClaims Reports window, select from the follow options:
Get Report – Select this button to download outstanding eClaim reports from the clearinghouse.
Purge Reports – Select this button to manually delete existing claims reports.
Print Report – Select this button to print all available reports.
Close – Select this button to close the eClaims Reports screen.
Navigate To
Use the quick navigate buttons to launch the following windows:
Patient
Transaction
Insurance
User’s Guide – Patterson PTOS 5.6 Billing
121
Select Close to exit the Claims Queue.
Re-creating a Claim
There are many options when re-creating a claim in PTOS.
To re-create a closed claim WITHOUT making any changes, use the Recreate Claim option in cogwheel in
Patient Editor or Patient Transactions. To re-process an open claim, simply highlight the claim in the Claims Queue and process it again.
To re-create a closed claim after making a change to the
PATIENT or INSURANCE demographic/setup information
(e.g. ID#, address, HCFA setup, etc), use the Recreate
Claim from cogwheel in Patient Editor or Patient
Transactions. To re-process an open claim, simply highlight the claim in the Claims Queue and process it again.
To re-create a closed and processed claim after making a change to the TRANSACTION, you will need to re-bill using the Insurance Billing window.
eClaims Setup Tab
For assistance, please contact an eServices representative to help set up your eClaims.
In the eClaims tab, under Clearinghouse Settings, enter the following information:
eClaims Provider – Use the drop-down menu to select the clearinghouse.
Login – Enter the User name
Password – Enter the password
User’s Guide – Patterson PTOS 5.6 Billing
122
Reports can also be manually retrieved and purged in the eClaims Reports screen under the Claims Queue.
Other Clearinghouse File Path – Use the Browse button to locate the clearinghouse file path if applicable. This option is only available if you are using ‘Other’ as your designated eClaim provider.
Print Image File Name – Enter the name desired for using
Print Image files for sending eClaims.
Under Default Reports to be Printed, select the checkbox associated with the reports that you wish to print automatically when processing claims.
Acknowledgment of
Receipt
Amend File Detail (RPT04A)
997 Batch & Claim Rejection (RPT05)
File Status (RPT02) Amend Batch & Claim Rejection
(RPT05A)
File Summary (RPT03) Provider Claim Status (RPT10)
File Detail (RPT04) Special Handling/Unprocessed
Claims (RPT11)
Under Report Settings, select the checkbox Save Reports to save these reports to Documentation. Select the number of days after which you wish to Purge reports. Purged reports will be completely removed from your PTOS database.
Select Save to save your selected setup. Select Default to restore the default settings. Select the Cancel button to exit without saving.
Auto Assign Payer ID
Any Insurance company that has been designated to Auto Assign
Payer IDs can be assigned or updated using the Auto Assign
Payer ID button in the eClaims Setup tab. To designate an insurance company for auto assign, select System Tasks
Update Lists
Insurance Companies.
Select the … button to open the Electronic Payer Name Matching screen. In this window, select the PTOS payer and match them to the Electronic Payer. Select OK.
User’s Guide – Patterson PTOS 5.6 Billing
123
This will default the Auto Assign Payer ID checkbox in the
Insurance Company screen.
Auto Assign Payer IDs in the eClaims Setup Tab
Select the Auto Assign Payer ID button to update and assign any new payer identification numbers.
Select Yes to continue. Select No to close without updating.
Setting up Unpaid Balances
To setup the Unpaid Balance defaults, go to Billing
Insurance
Billing and select the eClaims Setup tab. In the eClaims Setup, select the checkbox Send Unpaid Balance Details to Additional
Insurance. Then use the drop-down boxes to select the default group code and the default reason code.
User’s Guide – Patterson PTOS 5.6 Billing
124
Using Unpaid Balances
Unpaid Balances are used when communicating electronically with secondary or additional providers. For example, if the
Primary insurance paid $70 of a $100 charge, the unpaid balance would be $30. Use the Unpaid Balance checkbox to submit the
$30 along with the reason/group codes for why it was not paid to the Secondary payer. Unpaid Balances are only necessary when using electronic claims to Secondary or additional providers.
When closing a Primary claim with unpaid balance totals, verify the defaulted Unpaid Balance amount. Select the Unpaid
Balance Details button to view service level details. Otherwise, select OK.
User’s Guide – Patterson PTOS 5.6 Billing
125
Claims
In the Unpaid Balance Details window, review the unpaid balance. Unpaid Details convey information to additional payers and will not impact the case balance.
Select the Balance button to assign portions of the Unpaid
Balance to different code groups.
Select OK to create the Secondary or Additional Claim with
Unpaid Balance information.
The claims queue can also be accessed by selecting Billing
Claims.
ERA
Navigate in the Claims Queue using the navigation buttons.
Patient – Select the Patient button to open the Patient
Editor for the selected transaction.
Transactions – Select the Transactions button to open the
Transactions Summary and History window.
Insurance – Select the Insurance button to open the
Insurance information window for the selected claim.
ERA Queue – Select the ERA Queue button to open the
ERA window. (See Below)
ERA (electronic remittance advice) is an electronic file in an industry-standard format called ANSI-835. The file contains a number of transactions representing the payments and/or adjustments that a payer has determined to be appropriate for charges (claims) submitted by the provider.
User’s Guide – Patterson PTOS 5.6 Billing
126
View ERA in Claims
In the Claim screen, select the ERA Queue button. The ERA
Queue appears.
The ERA Queue
In the Electronic Remittance Advice Queue, select the From and
To dates to view a range of claims. Select the Show button to display ERAs.
In the ERA area, select a claim to view the basic information in the upper portion of the queue. Select the View (+/-) hyperlink to view the ERA. Select the Completed checkbox to mark the EOB as completed.
In the ERA area, select a claim to view the Claim detail in the lower portion of the queue. Select the EOB hyperlink to view the
Explanation of Benefits for the selected claim. Select the Claim hyperlink to view the claim. ERAs with Provider level
Adjustments will receive multiple warnings.
The following is an example of the provider level adjustment warning.
Select the Show Completed ERA checkbox to display closed claim information. View the Legend to distinguish the meanings of labels.
User’s Guide – Patterson PTOS 5.6 Billing
127
Overpayments - ERA Payments
When an ERA is received that causes an overpayment, you are warned when you attempt to save the ERA payment and are given a chance to review the payment details before processing.
Bulk Payments
Select the Bulk Payment button to make an insurance payment on a range of claims associated with the same Payer.
In the Bulk Payment window, select the Payment Date and
Payment Type. Enter the Bank # and Amount if necessary.
Select an Open Claim and view the Claim details in the lower panel. Select Automatic or Manual Distribution.
NOTE: The check amount and the amounts distributed to claims must match.
Date of Service Filter
Filter claims by Date of Service using a single date or a date range. The filter defaults to empty to allow you to see all claims prior to filtering.
For example: A claim with the service dates ranging from 6/1, 6/5 and 6/10 would display when filtered for date of service range 6/1
– 6/6 despite having the 6/10 dated entry.
User’s Guide – Patterson PTOS 5.6 Billing
128
Other Clearinghouses
Use the Browse button to locate an ERA associated with a
Clearinghouse other than Emdeon
®
. We do not guarantee that all clearinghouse information will be compatible with PTOS.
Claim Level Adjustments
There are three ways to handle claim level adjustments in PTOS
5.0:
Automatic Distribution – If you have your payments set to automatic distribution, PTOS will distribute the adjustment to the default adjustment type associated with the claim.
Manual Distribution – If you have your payments set to manual distribution, PTOS will prompt you to distribute the adjustment amount.
Unapplied – When using manual distribution, you will have the option to not distribute the adjustment amount thus leaving it unapplied in the account.
Flexible Bulk Payment Distribution
Flexible Bulk Payment Distribution allows you to select the desired claim and then automatically distribute the amount you entered among the services on the selected claim. This gives you the convenience of automatic distribution and the flexibility of manual distribution.
Setting Up
In Config Parameters
Billing, select Use Partial Automatic
Distribution in Bulk. Select the Edit icon and change the Value to Yes.
User’s Guide – Patterson PTOS 5.6 Billing
129
Select the claim based on
Config Parameter settings.
Flexible Bulk Payment Entry
Automatically distribute to services.
Enter the payment amount.
Our new distribution method allows you to select which claim on which you wish to distribute payment. example, $200)
2. Select the desired claim in the Claim level window.
3. Manually enter the payment amount on the claim.
PTOS will then auto-distribute the amounts to the services in the lower services portion.
Reset Warning
Changing the check amount after you have begun entering information will launch a warning message. This warning is to inform you that making the change will result in all entries being reset to $0.00.
Overpayments - Bulk Payment Windows
Payments with an amount greater than the balance can now be made in both the bulk and regular insurance payment windows.
Visual indicators have been added to warn you when an overpayment is applied.
In the top grid, the Ins Pd Amt field turns orange with a tooltip to indicate any previous overpayments already saved for that claim.
In the bottom grid, the Pay Amt field turns orange with a tooltip indicating the overpayment amount for that particular charge. In addition, orange text detailing the overpayment amount appears at the bottom of the window near the distribution fields.
User’s Guide – Patterson PTOS 5.6 Billing
130
Example: A full insurance payment has been made on a claim where the patient has already made a $20.00 payment. In this case, the $20.00 patient payment is moved to unapplied so that the entire $100.00 insurance payment can be distributed to the claim.
HIPAA (ASC) X12 Version 5010 Standard
The HIPPA 5010 standard for electronic claims and ERA is an industry mandate with a deadline of January 1, 2012. This standard is utilized when processing both eClaims and ERA.
Only the Professional Claims 837-P and Remittance 835 are included. Institutional 837 is not included.
If you are using PTOS eServices, the transition to 5010 will be seamless. If you are using another clearinghouse for electronic claims, please visit www.ptos.com/5010 for instructions on downloading a 5010 test file to be sent to your clearinghouse for approval.
NOTE: This only applies to electronic claims. If you are using print image output files or paper claims, you will not be impacted.
To inquire further about PTOS eServices call 800-824-4305.
User’s Guide – Patterson PTOS 5.6 Billing
131
Worklist
Using the Worklist
The Worklist is a handy way of keeping appointments and notes organized by Treating Therapist and Date.
Appointments
In the Appointments tab, use the drop-down lists to select a
Therapist and Date. In the Appt Filter, select Show All, Show
Incomplete and Show Complete.
Use the Refresh button to apply changes to the current view.
Use the Patient Chart button to open the Patient Chart window.
Notes
In the Notes tab, use the drop-down lists to select a Therapist and Date Range. In the Status Filter, select Open Notes,
Closed Notes and Void Notes.
Use the Refresh button to apply changes to the current view.
Select Patient Chart to view chart information in the Worklist.
User’s Guide – Patterson PTOS 5.6 Worklist
132
Interfaces
Using Interfaces
Interfaces allow you to seamlessly share data with third-party software programs.
Config Parameters
To set up your Import and Export folders, select System Tasks
Supervisor
Config Parameters. Use the drop-down list in
Config Group to select Interface.
Allow plenty of time for the file export to complete.
Set your Data Export and Data Import to XML. Enter the path
(location) where you wish to store the exported data. The Export folder path contains the exported patient demographics. Enter the path (location) where manually imported XML files will be stored.
The Import folder contains any files that have been manually imported.
Exported Files
PTOS 5.0 automatically exports all demographic files to the designated Export folder. Once files have been exported to this folder, a new file will be created in the export folder whenever files have been added or edited.
User’s Guide – Patterson PTOS 5.6 Interfaces
133
One Time Export
To export your patient demographics to XML, select Special
Tasks
One Time Export.
The following window appears.
Select Yes.
Select OK. Exported files will now appear in the folder that was designated in Config Parameters. Once files have been exported to this folder, a new file will be created in the export folder whenever files have been added or edited.
Import Files
To import XML files into PTOS, select Special Tasks
Data
Import.
The following window appears.
User’s Guide – Patterson PTOS 5.6 Interfaces
134
Select OK. The following window appears.
Select OK.
Select OK.
Review the Import Summary. Select View Import Log to preview a report of Import information. Select OK.
User’s Guide – Patterson PTOS 5.6 Interfaces
135
Reports
Report Options
Multiple options allow you to control how you receive report data.
Report Views
View your reports onscreen in either GridView or ReportView.
GridView – Select this option to view the information in a data format. Use column headings to sort the data.
ReportView – Select this option to view the information in a standard report format.
Export Options
Select the Export icon to select a format in which to save the report to a location outside of PTOS.
Select Text, Excel, CSV, XML or HTML.
NOTE: Other software programs may be required for viewing reports in other formats.
User’s Guide – Patterson PTOS 5.6 Reports
136
Favorites
To add a report to Favorites, select the Favorites icon which appears as a yellow star. When a report has been added to
Favorites, the yellow star appears white and the report name appears in the Favorites heading from the Reports drop-down menu.
Aged Accounts Receivable Reports
Under Reports, select Aged Accounts Receivable Reports to create a report with by selecting from the following options:
Facility Select the desired facility from the available options.
Account Type
Insurance Company
Select the desired Account Type from the available options.
Enter an Insurance company to narrow results by Insurance Company only.
Therapist Select the desired therapist from the available options.
User’s Guide – Patterson PTOS 5.6 Reports
137
Report Type
Case Status
Amount
Include Zero
Select Summary or Detailed.
Select the desired case status from the available options.
Select Allowed Amount or Charged
Amount.
Select the checkbox to include zero on the report totals.
Credit Balances
Break down Balance into Patient and
Insurance
Select the checkbox to include credit balances on the report totals.
Select the checkbox to display patient and insurance balances separately.
Include Charge per day Select the checkbox to include charge per day.
Group Results By options:
Account Type Select this option to group the report results by Account Type.
Case Status Select this option to group the report results by Case Status.
Facility
Primary Insurance
Therapist
Select this option to group the report results by Facility.
Select this option to group the report results by Primary Insurance company.
Select this option to group the report results by therapist.
Customized Date Range A/R Report
Select the Facility and Account Type from the available options.
Enter the Days Range amounts. Select Refresh to reflect the changes in the data.
User’s Guide – Patterson PTOS 5.6 Reports
138
Analysis Reports
Under Reports, select Analysis Reports to create a report with the following options:
Account Type Summary
This report shows how many new, discharged, treated and patient marked
‘active’ for each Account Type. They are grouped by the Account Type. It is only considered a new patient if their first visit date falls within the date range of the report.
Billing Efficiency
Collection/Transaction
Analysis
This will show every claim or statement that was sent during the period you specify. Also shown, are the total number of bills sent, the total amount billed, and the smallest, largest and average size bill.
This report shows all charges, insurance and patient payments, debit, and credit adjustments, visits, and units for each day of the month, or other time periods you’ve selected with totals for each category. If you wish, you can include a second line for each day which will show the expected amount and total payments received.
Diagnostic Statistics
Collections Efficiency
Delinquency Report
This report prints in two different formats depending on whether you select all patients of DISCHARGED PATIENTS
ONLY.
This report shows the total of charges within the specified date range along with the total insurance payments, patient payments, adjustments, and the average number of days it takes to collect the first payment.
This is a list of all accounts that have notes entered in Patient Editor field ‘Delinquent
Report Note’. Select accounts with balances over 30, 60, 90 or 120 days or no recent payments. Print one account type or sort by patient number or by account type.
Insurance Tracer
Medicare Log
This report shows all ‘open’ claims.
Claims that have been marked ‘final’ will not display.
This option is designed as a summary of activity for Rehab Agencies. Total insurance and patient payments, and credits for these charges are included.
User’s Guide – Patterson PTOS 5.6 Reports
139
Monthly Collections
This report shows the aging of charges paid for the date range selected.
Outcome Edit List Report This is a listing of discharged patients that will be referenced in the #3.92 Outcome
Summary Report Outcome Reports provide important management data.
When you select this option, the following menu appears. You must first select
“Prepare Outcome Reports” option. This compiles outcome data for all discharged patients. It is similar to Prepare Aged
Accounts.
Outcome Summary
Report
C.P.T. Code Summary
Referral Analysis
This is a list of important management data for all discharged patients.
The C.P.T. Code SUMMARY will then total the number of times each procedure was used during the period, the charges billed for each procedure code and “I”
(individual) codes. You also have the option of choosing to include “I” codes
ONLY. If you choose “I” codes only, all “I” codes (individually entered charges) are sorted and subtotaled by DESCRIPTION.
The report can be grouped by
THERAPIST, ACCOUNT TYPE or
LOCATION.
This report is valuable in analyzing which doctors are sending profitable referrals.
Running the report on a monthly basis provides an accurate gauge of increasing or decreasing activity of various physicians.
Treating Therapist Activity This report is useful in measuring the productivity of treating therapists. The statistics can be used to assign patient loads, calculate bonuses, and analyze treatment trends.
Assigned Therapist
Activity
This report is useful in measuring the productivity of assigned therapists. The statistics can be used to assign patient loads, calculate bonuses, and analyze treatment trends.
Treatment Lists
Under Reports, select Treatment Lists Reports to create a report with the following options:
User’s Guide – Patterson PTOS 5.6 Reports
140
Privacy (HIPAA)
Notification
Discharge/Inactive
Dropout
Notes
This report shows patients and their HIPAA
Authorization and Privacy Notification dates.
This report shows patient cases by
Discharge Date, Condition and/or Inactive
Patients with their first and last visit dates.
This report shows the patients considered as
‘dropouts’.
This report shows Case Notes and/or
Additional Notes on patient cases.
First/Last/Return Visits This report shows patients by their first, last and return visit dates.
Diagnosis List
Injury Area/Date
Patients By Referral
Auth Alert/Remaining
Visits
Patient Therapist
Listing
This report shows patients by their Primary
Diagnosis and other relevant details.
This report shows patients by their injury area and date.
This report lists Referring Doctor, Primary
Doctor, Attorneys or Case Managers with a listing of the respective patients that have been assigned to each.
This report lists cases that are within a certain # of visits of the Auth Visit Limit and/or cases where the Auth Exp Date falls within the date range specified.
This report shows a listing of patients and their Assigned Therapist.
Payment Plan
Deductible
No Activity
This report lists patients who have a payment plan amount set in Patient Editor.
This report shows patients with a deductible set in Patient Editor.
A listing of patients who have had no activity prior to a certain date.
Financial Lists
Under Reports, select Financial List Reports to create a report with the following options:
Case Balance Report This report shows all patients who have a balance within the range specified, including credit balances (Ex: Credit Balance = $-
150.00 to $-.01; Small Balance = $.01 to $25).
Charge Limit
Insurance Listing
This report will show patients who have met or exceeded their charge limit.
This report lists all patients by either Primary,
User’s Guide – Patterson PTOS 5.6 Reports
141
Secondary, Third or Other Insurance within a specified date range.
Responsible Party List This report shows patients by Responsible
Party
Case Overview
Authorization Number
This report shows patient cases and specific details chosen in the filter.
A listing of patients showing their authorization number assigned within a specific date range.
Demographic Lists
Under Reports, select Demographic Lists Reports to create a report with the following options:
Patient Employer
Patient
Address/Birthdate
This report shows a listing of patients by their associated employers and/or occupation.
This report is a listing of patient addresses and their birthdates.
Patient Additional Info
This report is a listing of additional patient information, including: email, Home #, Work
#, 1 st
visit, Last Visit, Referring Doctor and
User Defined Field.
Cover Sheet This report provides a ‘cover sheet’ containing the data entered on the Patient
Data screens.
Code Lists
Under Reports, select Code Lists Reports to create a report with the following options:
Account Type
This report is a listing of all Account Types set in the system.
CCI Dataset
LCD Dataset
This report is a listing of CCI Edits and the respective information attached to each.
This report is a listing of LCD Edits and the respective information attached to each.
C.P.T. Codes
C.P.T. Group
Referrals
This report is a listing of C.P.T. Codes and the info recorded for each in the system.
This report is a listing of C.P.T. Groups
Terminology groups.
This report is a listing of all Doctors, Attorneys or Case Managers and pertinent information
User’s Guide – Patterson PTOS 5.6 Reports
142
Employers
Fee Schedules for each.
This report generates a list of Employers.
ICD9 Codes
Insurance Companies
This report generates a list of International
Statistical Classification of Diseases and
Related Health Problems diagnosis codes.
A listing of all Insurance Carriers, their codes and information as setup in the system.
Lookup Table
This report generates a list of fees by Fee
Schedule.
Employee
Payment Type
Adjustment Type
This report displays all of the abbreviation codes located in the Lookup Table.
This report is a listing of all existing Employees with their correlating information.
This report is a listing of the Payment Types.
This report is a listing of the Adjustment Types.
Transaction Lists
Under Reports, select Transactions Lists Reports to create a report with the following options:
Adjustments This report generates a list of adjustment types.
Bank Deposit Slip
Charges
Charges and
Payments for Primary
Insurance
This report lists all information pertinent to the
Bank Deposit Slip.
This report shows all charges (billed and unbilled) in a specified date range.
This report is a list of charges and payments grouped and subtotaled by the patient’s primary insurance.
Daily Transaction
Report
This report lists entered transactions for a specified date range for all facilities.
Payments
Unapplied Monies
Unpaid Charges
Voided Transactions
This report is a list of payments subtotaled by date.
This report is a listing of all unapplied payments and adjustments.
This report is a listing of charges and their remaining balances.
The report is a list of any voided transactions within a specific date range.
Transaction Audit Trail This report shows all Transactions for patients within a specified date range.
User’s Guide – Patterson PTOS 5.6 Reports
143
Documentation Reports
Under Reports, select Documentation Reports to create a report with the following options:
Document Listing
Open Notes Report
This report shows any documents that are closed, open or all for a specific time period and/or Therapist. The report is broken down by Facility with totals per Facility and Grand
Totals for Patients/Case.
Displays active patient/cases that have one or more open notes broken down by
Therapist.
Deferred Note Closing
Report
Charge-Time Audit
Report
Charge Ticket/Claim
Form comparison
Report
This report shows the number and percentage of notes that are closed between
DOS + 3 days and those closed after 3 days.
This report compares the documented time
(in a note) to the number of units for that same visit. The note must be linked to the appointment for the results to display.
This report compares the charges entered by the Therapist to the charges included on the claim form for that same visit.
Scheduling Reports
Under Reports, select Scheduling Reports to create a report with the following options:
Appointment List
This report is used to print a list of patient appointments by Facility, Date and/or
Appointment Status.
Appointment
Reconciliation Report
Cancel/No Show
Co-Payment
Reconciliation Report
This report is used to identify appointments that have not been completed by the
Therapist or front desk.
This report shows the number of scheduled, cancelled and no-show appointments in a user-specified time period for each therapist in a facility or for all physicians referring to the facility.
This report is used to reconcile the copayments collected (cash, check, creditcard, other) with the payments listed on the bank deposit slip.
C.P.T. Utilization
Report
This report displays the average and total # of units for each unique C.P.T. charge code
User’s Guide – Patterson PTOS 5.6 Reports
144
Daily Schedule
Patient Appointment
Reminder
Patient Sign-in Sheet
Next Physician
Appointment Report
Superbill List
Superbill Print
Therapist Schedule
Report
Weekly Appointment
Report billed with the start/end period.
This report is a listing of patients scheduled for a Facility and/or Therapist by appointment date.
The report is a list of patients with upcoming appointments for confirmation.
The report creates a form for collecting patient signatures upon arrival.
The report displays active patient/cases that are within a selected time frame.
This report displays a list of patients who have a scheduled appointment by specific date. It can be printed for a specific patient and date range.
This report creates individual Super Bills for patients. The Super Bill will only contain
C.P.T. Codes that were marked ‘To Include on Super Bill’.
This report displays patient appointments for the date range specified.
This report displays the number of appointments/week for a five week period for each Therapist in the facility or for all physicians referring to the facility.
User’s Guide – Patterson PTOS 5.6 Reports
145
System Tasks
Supervisor
In this section, use System Tasks to manage a group of supervisor items.
Config Parameters
Use the drop-down menu to select a Config Group. To edit an existing entry, select the entry and select the Edit icon. See the
Using PTOS chapter for more information in setting up Config
Parameters.
User’s Guide – Patterson PTOS 5.6 System Tasks
146
Multiple Data Sources can be set up but at least one data source must be active to prevent loss of data.
Data Sources
Setup your data source information to designate the location of your database information.
Data Source Name – Enter the Data Source Name.
DB Server – Enter your Database server location.
DB Name – Enter your Database Name.
DB User Name – Enter your Database user’s name.
DB Password – Enter your Database password.
Test Connection – Select the Test Connection button to check the connection to your database server.
NOTE: Asterisk (*) denotes required field.
Facility
For information on setting up facilities, see the Using PTOS chapter of this document.
Employee
For information on setting up employees, see the Using PTOS chapter of this document.
User’s Guide – Patterson PTOS 5.6 System Tasks
147
Merchant Services Setup
After completing your enrollment with eServices, set up your X-
Charge by selecting System Tasks
Supervisor Merchant
Services Setup.
In Merchant Services Setup, under X-Charge Transactions, select the checkboxes for Process Credit Cards, Process Debit
Cards and Process Electronic Checks. Enter your X-Charge
Username and Password and Merchant ID numbers for all locations. Select Save to save.
User’s Guide – Patterson PTOS 5.6 System Tasks
148
To setup payment information, select System Tasks
Update
Lists
Payment Types.
In the Payment Types window, new payment types are available for Electronic Check and ATM/Debit Card.
To collect an X-Charge payment, select Billing
Payment/Adjustments.
User’s Guide – Patterson PTOS 5.6 System Tasks
149
In the Account Payment window, select the desired transaction.
Use your card reader and follow the prompts.
User Access Rights
For information on setting up User Access Rights, see the Using
PTOS chapter of this document.
User Groups
User Groups are assigned to employees in the Employee screen. Another way to assign employees to User Groups is under System Tasks
Supervisor User Groups.
Select the User Group drop-down arrow to select a User Group.
Select Add Employees to User Group to add employees.
Select the checkbox associated with the desired employee.
Select OK.
To create a new User Group, select the Add icon or F2. Enter the description information and save.
User’s Guide – Patterson PTOS 5.6 System Tasks
150
To delete an existing User Group, select the desired group and select the Delete icon.
Check for Updates
For information on checking for updates, see the PTOS chapter of this document.
Update Lists
The Update Lists menu allows you to make modifications to your lists. For more information on updating lists, see the Using
Update Lists section of the PTOS chapter of this document.
Login Summary
Select the Login Summary to view the login users for a userdefined date range.
Use the drop-down list to select a From and To date from the calendar. The current date defaults in the From and To fields.
Use the drop-down list to select a User Name.
Select Refresh to update the list. Select Export to save this file in another format elsewhere on your computer. Select Remove log
Data to delete the log file of login information.
User’s Guide – Patterson PTOS 5.6 System Tasks
151
Currently Logged Summary
In the Currently Logged Summary tab, view a list of users that are logged into PTOS. Select Remove to remove a user from the system. Select Export to save this file in another format elsewhere on your computer.
Object Lock Details
In the Systems Tasks, select Object Lock Details to locate and release any locked files.
Select the specific file from the list and select the delete icon or select the Clear All Locks button to unlock all files listed.
Export Application Errors
Use this option to save application errors to an external file.
These files may be useful for working with Support to diagnose errors.
User’s Guide – Patterson PTOS 5.6 System Tasks
152
Go to System Tasks | Export Application Errors. Use the dropdown list to select the file type. Select the Export button. Browse to the desired location to which you wish to save the file. The following window appears.
Select OK to save the file and return to PTOS.
Technical Support Utility
The System Copy and System Restore options are utilities to be used by the Technical Support team when performing certain tasks and maintenance. These copies should not be used in place of an external system backup.
System Copy
For more information on
backing up your database securely, contact your local
Hardware provider.
User’s Guide – Patterson PTOS 5.6 System Tasks
153
Under System Tasks, select Technical Support Utility
System
Copy. Select the data source to be copied: Main and/or Archive.
Select OK to continue. Select Cancel to exit without copying your database.
Select Yes to continue.
Select OK.
Select OK.
Copy Size
It is important to get a good backup of your PTOS data. If you save documents larger than 4GB, the System Copy may not be able to accommodate your entire backup.
If you have a larger than normal database or save large documents, use an additional backup system to ensure that you are backing up all of your data.
User’s Guide – Patterson PTOS 5.6 System Tasks
154
Restore Copy
Under System Tasks, select Technical Support Utility
Restore
Copy. Use the drop-down list to select Main or Archive for your data source. Select the Browse button to locate your copy file for restoration.
Select Continue to begin restoring a copy. Select Cancel to exit without restoring.
Select OK to continue.
Select OK to continue. Restart the application prior to continuing to work in PTOS.
Select OK.
User’s Guide – Patterson PTOS 5.6 System Tasks
155
Special Tasks
Remove Old Accounts
Under Special Tasks, inactivate and archive your data.
Inactivate Cases
To remove discharged or otherwise completed cases from menus, use the Inactivate Cases option.
Archived cases cannot be retrieved without restoring a backup of your database. Do not archive cases unless you are completely finished with them.
Prior to Inactivating cases, you must set the case to inactive using the Cogwheel menu in Patient Case.
To inactivate cases, select Special Tasks
Remove Old
Accounts
Inactivate Cases. Select the Discharged prior to
date, the Last Visit prior to date, Dropped out prior to date and
Last Payment made prior to. Under Case Status, select Active
Cases, Discharged Cases or Show All. Select the desired patient to be inactivated or use the Select All checkbox.
Choose Inactivate & Archive to inactivate the selected patient(s) and archive the information. Choose Inactivate to inactivate the patient without archiving. Select Close to exit.
Archive Patients
To archive patients, select Special Tasks
Remove Old Cases
Archive Patients.
User’s Guide – Patterson PTOS 5.6 Special Tasks
156
Archived cases cannot be retrieved without restoring a backup of your database. Do not archive cases unless you are completely finished with them.
Select OK to continue.
Select the name of the database that you wish to access. Select the Choose checkbox for the desired patient or select the Select
All checkbox. Select the Archive Data button.
Add/Update Client Logo
Add your logo to be used on documents and reports. To add or update your logo, select Special Tasks
Add/Update Client
Logo.
Note: Your image should be no larger than 120 x 120 pixels.
Select the Add/Update Client Logo to upload a new logo image.
The image must be a JPEG. Select Remove Client Logo to remove the logo without replacing the image. This logo will be added to various reports and documents throughout PTOS.
User’s Guide – Patterson PTOS 5.6 Special Tasks
157
Tools
Worklist
For information on Worklist, see the Worklist section of this document.
Login as Different User
In the Tools menu, select Login as different user to switch accounts without exiting PTOS.
Select the date using the calendar or select the Today button.
The calendar will default to today’s date. Enter the User Name and Password and Login.
User’s Guide – Patterson PTOS 5.6 Tools
158
Help
PTOS Help Menu
Select Help
PTOS Help to access a searchable help menu designed to explain and inform.
Online Center
The Online Center is a hub of web-based information that is available for PTOS users. Access these websites outside of
PTOS software.
Contact Support
Select Help
Online Center Contact Support. The following appears.
FAQ
FAQ is our searchable only database. To access FAQ, select
Help
Online Center FAQ. Use FAQ to ask questions, retrieve answers or learn more about PTOS.
Use the drop-down arrow to select a Patterson Product. Enter keywords or phrases into the Search by Keyword field and select
Search.
User’s Guide – Patterson PTOS 5.6 Help
159
About PTOS
Select Help
About PTOS to review your individual license information.
System Backups
Having a secure external backup is vital to protect your office data. As of PTOS 4.5, it was be required that you use an external backup system to obtain your nightly, monthly and yearly database backups. As a result, the backup option in PTOS will no longer be available as it is not sufficient to fully protect your valuable data.
Creating Your Backup
Locate the following files and folders in your PTOS directory:
PatientStatements folder
RtfDocuments folder
ScanDocument folder
SignedRtfdocuments folder
SignedPdfdocuments folder
Images folder
ClaimImageFiles folder email_template.txt file the xmlvalues.xml file within the CaseResultDocuments folder
These files contain your office’s important data and should be backed up nightly.
In addition to the above files/folders from your PTOS directory, you will want to create a System Copy from within your PTOS system. This should be done daily. To create a system copy, go to System Tasks | Technical Support Utility | System Copy. For more information on how to create a .bak file, please visit FAQ.
Your .bak file as well as the files and folders listed under Creating
Your Backup should be backed up nightly, monthly and annually using an external backup media.
Storing Your Backup
Once you’ve completed your database backup, it is important that you store your data on an external media, preferably one that can be stored off-site.
Please contact your local hardware provider for more information on secure external backup systems for your office.
User’s Guide – Patterson PTOS 5.6 Help
160
Glossary of Terms
%
Allowed Amount
AMA
The percent sign is used throughout PTOS 5.0 like a Macro key. It replaces the
F2 key used in PTOS 3.5. Various boxes throughout PTOS 5.0 that ask you to enter a code will allow you to type % and then press <Enter>. A box will appear listing available codes, up to the first 500, for the specific field you are in. Doubleclick to make a selection from the box.
Set in FEE SCHEDULE code and/or C.P.T. code setup, this is the payment amount the insurance allows for a specific C.P.T. code.
American Medical Association
A/R
A common abbreviation representing accounts receivable, which is the total dollar amount owed to the facility by insurance and patients for services rendered.
Assigned Therapist
This is the provider who is established at the time of patient intake as the one most likely to perform the patient’s care. However, depending on the particular patient visit, other providers may treat the patient (i.e. the assigned therapist may be busy, on vacation or have other reasons to delegate care to others). Such other provider is called the treating therapist for a particular patient visit.
AT (account type)
A two-character code that classifies different accounting and insurance criteria so that certain groups of people with a particular account type all have the same criteria applied to them.
FEE SCHEDULE
Code (Billing Code
Translation)
Billing Service
A code defined for a specific insurance company within the code set up for system administration. It is becoming more common for the patients’ primary insurance to use one type of coding system and the secondary carrier to use something different. Billing Code Translation automatically converts to the appropriate code.
A type of PTOS customer who performs medical billing services for multiple, usually unrelated medical offices. Billing services present several special needs that are taken into account within PTOS 5.0. Billing services typically only use the
Billing module, not Scheduling or Documentation. Special licensure should be obtained for billing services.
User’s Guide – Patterson PTOS 5.6 Glossary of Terms
161
CCI/LCD Audit
The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. Go to http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp?listpage=2 .
Find Code Ranges 90000 – 99999 (for physical medicine or physical therapy…).
The CCI Audit prevents using conflicting C.P.T. codes, depicting when a modifier should be used or two codes should be billed together. CMS updates these rules every three months. PTOS 5.0 users receive special instructions on how to manually update their system with these codes. LCD Audits can be run simultaneously with the CCI Audit. The LCD (Local Coverage Determinations)
Audit is a check to ensure that C.P.T. Codes and DX Codes are payable when billed together. The rules for LCD are determined by local financial intermediaries http://www.medicare.gov/basics/lcds.asp
. If there is a conflict, the audit will warn you that the C.P.T. Code will not be paid with that DX code. You can modify the transaction at that time and run the audit again to make sure it passes.
An insurance form used by most health professionals and insurance companies.
CMS 1500 (HCFA) form
Cogwheel icon
Co-insurance
Co-pay
Appears in the upper right-hand corner of various screens throughout PTOS 5.0.
If the cogwheel icon option is chosen, a drop-down menu appears with different functions that can be chosen.
The patient is responsible for a co-insurance amount, which is a calculation, based on patient insurance benefits (ex: 20% of allowed amount on an 80/20 plan).
The dollar amount set in the Patient Editor that the patient is responsible to pay
(i.e. $10 co-pay per visit).
C.P.T. code
(Current Procedure
Terminology)
A C.P.T. code system describes medical and surgical procedures and services performed by physicians and other health providers. The system was developed by the American Medical Association (AMA) and serves a number of purposes. It is essential to billing for patient care services. The 5-digit C.P.T. code is defined by the AMA for all types of medical procedures. In PTOS 5.0, as in most medical billing software systems, the C.P.T. code is an important parameter to keep track of because this code appears in the billing form (whether submitted electronically or on paper) in order to receive reimbursement. However, as strictly defined here, a C.P.T. Code is only one type of procedure code. A yearly revision is made to the C.P.T. CODE by the AMA. PTOS 5.0 currently does not have functionality to automatically update these codes. Customers can manually update their codes using the latest revision provided from the AMA website and/or handbook.
However, PTOS 5.0 allows the user to set up any combination of numbers and letters as a C.P.T. /procedure code.
C.P.T. group code
A collection of frequently used codes together under a different designated code to make posting easier when repetitive procedures are performed.
Customer
DOS
The entity that licenses PTOS 5.0. It is typically a medical practice, but may also be a billing service. A customer may consist of one or more facilities and one or more users within a facility.
Date of Service.
DX
The medical abbreviation for Diagnosis.
Insurance expected
The amount the insurance is expected to pay based on calculations.
amount
Extended amount
A calculation derived from the actual amount of the charge multiplied by the number of units.
User’s Guide – Patterson PTOS 5.6 Glossary of Terms
162
Facility
ICD9 code
(International
Statistical
Classification of
Diseases and
Related Health
Problems)
ICODE
Modifier
OT
POS
Provider
PT
PTOS 5.0
PTPN
REV code
ST
Treating therapist or PT
UB04 CMS 1450 form
A physical office or treatment center where medical services are provided to patients. For example, if a single corporate entity (i.e. a partnership or corporation) has three separate addresses where patients are seen, then this counts as three facilities. If there is one physical address where patients are seen
(or billing is performed, as in the case of a billing service), but three different entities (usually evidenced by different Tax Identification Numbers), then this also counts as three facilities.
The ICD9 coding system is an international disease classification system that groups related disease entities and conditions for the purpose of reporting statistical information. The National Center for Health Statistics (NCHS) and
Center for Medicare and Medicaid Services (CMS) publish annual revisions of these codes. PTOS 5.0 currently does not have functionality to automatically update these codes.
Sometimes a procedure code doesn’t describe a specific treatment. An ICODE can be entered for the charge and PTOS 5.0 will then allow a unique description, units, amount and the allowed amount. This is a way to designate when extra time or work was done on a patient (i.e. special splint, record copies). It is a onetime use code, not a permanent code.
This is a type of code (typically two numbers or letters) that conveys special information about the charge being billed to an insurance carrier. For example, if two charges are being billed that are generally considered by the insurer to be medically inappropriate (and therefore not reimbursed), the use of a particular modifier may signal special patient circumstances that enable the charge to be paid. Or, as another example, providers may, under special medical circumstances, receive reimbursement for patient care above the annual
Medicare reimbursement cap. The use of the modifier signals to the insurer that these conditions have been met.
The customer may be in violation of the law and suffer penalties if modifiers are inappropriately used.
Occupational therapist.
Place of Service
The individual person who provides a medical procedure. In the context of this specification, this usually means a physical therapist (PT), occupational therapist
(OT), or speech therapist (ST), but could also mean a Chiropractor or MD.
Physical therapist.
A modular practice management software system written primarily in C# and running on a SQL Server database.
Physical Therapy Provider Network
A revenue code is a three-digit number that rehabilitation agencies use in conjunction with a C.P.T. code to designate the type of discipline used to treat the patient. Once set up, the REV code will print in its special space, box 42 of the
UB04 CMS 1450 form.
Speech therapist.
The actual provider (i.e. physical therapist) who performed the procedure on a patient.
An insurance form used by certain types of providers (States of Florida and
Michigan, Rehabilitation and Comprehensive Rehabilitation Facilities (CORF).
Requirements vary between states and/or agencies.
User’s Guide – Patterson PTOS 5.6 Glossary of Terms
163
Unapplied monies
Payments posted to accounts that are not attached to any specific line item. The money shows as unapplied monies or unapplied bal throughout PTOS 5.0 screens.
Unit
A medical billing term used in the industry that means a Unit of medical care. The
UPIN
exact definition varies by the type of procedure. There are timed and untimed procedures. For an untimed procedure, it is considered to be one unit regardless of the amount of time it took to perform. For a timed procedure, the number of units depends on the amount of time to perform the procedure. Fifteen minutes is typically considered a unit, but can range between 8 and 22 minutes. A patient visit can have one or more units, depending on the procedure.
Unique Physician Identification Number
User’s Guide – Patterson PTOS 5.6 Glossary of Terms
164
PTOS Website
Visit the PTOS website www.ptos.com
to keep your business upto-date.
The PTOS website has several features available for your use.
Additional Seminars
A list of PTOS seminars is listed on the website. From the main page select the Seminars tab to view the list. Registration for these seminars is required and seating is limited so be sure to call and reserve your seat!
FAQ
Also available on our website is FAQ, our online frequently asked question database. Click the Support tab from the main page, and then choose PTOS FAQs. FAQ is available to all PTOS users to assist with any questions you may have. Not enough time to call support? Use FAQ to help answer your questions!
Enhancement Suggestions
Do you have ideas on how to improve PTOS? Visit our website and click the Enhancement Suggestions button on the main menu.
Enter your name, email address, and ideas and send them directly to us!
Support
Select the Support button to access Live Chat. Live Chat allows you to open a text dialogue with a Patterson technology representative during business hours.
User’s Guide – Patterson PTOS 5.6 PTOS Website
165
Index
A
Adjustment Type 42
Appointment Warning Messages 90
Appointment/Block Hold Type 54
Archive Patients 151
B
Backup
Restore 149
Billing
Approve Daily Transactions 98
CCI/LCD Audits 102
Charge Ticket 89
Insurance Billing 114
Payments/Adjustments 91
Standard Options 111
Transaction History 97
Transactions 84
Void Transaction 103
C
CCI Datasets 50
Check For Updates 3
Claims 104
Electronic Remittance Advice 123
Claims Queue 117
Config Parameters 10
CPT Group 45
D
Documentation 72
Enter Charges 84
Note 75
Patient Chart 75
Pick Lists 74
Template Admin 72
E eClaims Setup 14
Email Reminders 68
User’s Guide – Patterson PTOS 5.6
Enhancement Suggestions 160
Exit 2
Export Application Errors 147
F
Facility Information 5
Facility Logo 82
FAQ 154, 160
Fee Schedule 46
G
Glossary of Terms 156
H
HCFA/UB04 21
Help 154
Help Menu 154
I
Insurance Payments 92
Interfaces 130
L
LCD Datasets 49
Local Area Network 1
Logging On 2
Login Summary 146
Lookup Table 40
M
Multiple Blocks 59
N
Note History 79
O
Object Lock Details 147
Index
166
P
Patients 15
Bill Tab 20
Case Information 16
Diagnosis 17
Emergency Information 16
Employer Details 20
Insurance Tab 30
Notes Tab 31
Options Menu 32
Patient Information 15
Personal Information 16
Primary Care Physician 19
Referral/Employer 18
PTOS Website 160
R
Remove Old Accounts 151
Reports
Age Accounts Receivable 135
Analysis Reports 136
Code List 139
Demographic Lists 139
Documentation 141
Financial Lists 138
Scheduling 141
Transaction Lists 140
S
Schedule
Appointment Block/Void 70
Appointment Views 68
Calendar View 67
Edit Appointment 61
Transfer Appointment 69
Scheduling 52
Appointment 55
Appointment Block Hold Status 53
Appointment Card 66
Blocks 58
Cancelling Appointment 61
Checking In 61
Co-Pay 64
Enter Charges 65
Multiple Appointments 56
User’s Guide – Patterson PTOS 5.6
No Show 62
Note Complete 66
Print Superbill 67
Reminder Email Template 54
Resources 52
Right-click 64
Show CXL/NS Appointments 67
Voiding Appointment 63
Waitlist 70
Setting Up eClaims 14
Employees 6
Employers 39
Payment Types 41
User Access 8
Zip Codes 40
Statement Queue 114
System Requirements 1
System Tasks 143
T
Tools 153
Transaction History 42
U
Update Code 34
Account Type Codes 37
CPT Codes 44
ICD9 Codes 44
Insurance Codes 34
Referral Codes 35
W
Worklist 129
Index
167
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project